How Viral Hepatitis Is Treated

Viral hepatitis is inflammation of the liver caused by a virus. There are five types of hepatitis virus: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). Each of these distinct pathogens target cells of the liver called hepatocytes.

Some viral hepatitis infections are acute (short-lived) and resolve on their own without treatment or consequences. Others progress silently for years or even decades. And some hepatitis viruses are common only in undeveloped parts of the world (although travelers to those regions may be susceptible). What's more, there are vaccinations for two hepatitis viruses (A and B) that are part of the recommended childhood vaccination schedule.

The implication of all these variables for treatment of hepatitis boils down to this: Acute viral hepatitis infections rarely require any treatment whereas chronic viral infections can lead to devastating and even deadly consequences if left untreated—specifically scarring of liver tissue (fibrosis) that can lead to organ damage (cirrhosis of the liver) or cancer (hepatocellular carcinoma).

Types of Viral Hepatitis

Treatment for viral hepatitis will depend on which virus is involved, whether the infection is acute or chronic, and what specific symptoms or complications are involved.

Hepatitis A, hepatitis E, and often hepatitis B are self-limiting diseases, meaning the immune system is able to destroy the virus that causes them without help. However, even these types of hepatitis sometimes cause mild symptoms such as nausea or muscle aches, which can be managed with rest, avoiding alcohol, and medications to treat symptoms.

Preventing HVA and HVB

Individual vaccines for hepatitis A and hepatitis B. There also is a shot that combines inoculation against HVA and HVB. If for some reason you did not get these vaccines as a baby, find out from your doctor if you should get them now.

Hepatitis C. In 20 percent to 25 percent of people with HCV, the infection clears on its own within six months. When symptoms persist for longer than that, the disease is regarded as chronic and requires treatment.

Hepatitis D, which occurs primarily in sub-Saharan Africa, the Middle East, and the northern section of South America, can only affect someone who already is infected with HBV, and so treatment for these two types of viral hepatitis are one and the same.

Hepatitis E. Again, infection with HEV is self-limiting. Note too that it's rare in the United States.

Home Remedies

As often as not, acute viral hepatitis doesn't bring on obvious symptoms. It isn't unusual for someone to become infected with a hepatitis virus and never know it: The infection clears on its own without treatment.

When an acute hepatitis infection does make itself known, the symptoms tend to resemble those of seasonal flu, such as fever, headache, joint pain, and nausea.

Often these symptoms will barely be noticeable—so mild they don't require any treatment at all. When they're more severe, they can be managed with plenty of rest and quality sleep, lots of fluid to prevent dehydration, and a diet of easy-to-digest, nutrient-rich foods to help support the immune system as it fends off the virus.

A Warning About Drinking

Alcohol is metabolized through the liver, so it's essential to steer clear of all beer, wine, and liquor if you have a known infection with a hepatitis virus. In fact, excessive drinking over the course of a lifetime can lead to alcoholic hepatitis, an extension of alcoholic liver disease.

Over-the-Counter (OTC) Therapies

Aside from analgesics (painkillers) for easing head and muscle aches that may develop as a result of a viral hepatitis infection, there are no over-the-counter therapies for hepatitis.

However, it's important to be aware that in the same way alcoholic beverages pass through the liver, medications do as well.

Acetaminophen (Tylenol, Excedrin, etc.) is one of these. The fact that it is contained in so many different products (such as multi-symptom cold-and-flu remedies and topical creams and ointments for muscle soreness ) raises the risk of an accidental overdose and subsequent liver damage.

A form of hepatitis can be caused by the excessive use of Tylenol and other versions of acetaminophen. For someone who has a viral hepatitis infection, taking these medications can exacerbate the risk of liver damage. Talk to your doctor about alternatives for dealing with headaches and other symptoms.

Prescriptions

When a viral hepatitis infection becomes chronic, it likely will require prescription medication chosen based on the type of virus that has caused the infection.

Hepatitis A. The drug type of choice for HAV usually is a corticosteroid. Examples include prednisone and budesonide.

Hepatitis B. Treatment typically is indicated for patients with high viral activity and elevated liver enzymes, particularly when cirrhosis has developed. Antiviral therapy may be less effective in those with severe or end-stage liver disease. The U.S. Food and Drug Administration (FDA) has approved seven prescription drugs for treating chronic HBV: Interferon and six other antiviral medications. Although none can clear the virus, they can effectively prevent it from replicating and causing damage to the liver:

  • Interferon (interferon alpha-2b or pegylated interferon)—a synthetic form of a protein by the same name that's produced by the immune system. Manmade forms of interferon for treating hepatitis include Intron-A (interferon alfa-2b injection) and Infergen (interferon alfa-2b recombinant). Both are highly effective, although they're expensive and have significant side effects. Interferon usually is given by injection over 24 to 48 weeks.
  • Epivir-HBV (lamivudine)
  • Hepsera (adefovir dipivoxil)
  • Tyzeka (telbivudine)
  • Baraclude (entecavir)
  • Viread (tenofovir)

Hepatitis C. The drugs approved by the FDA to treat a hepatitis C infection are newer generation direct-acting antivirals (DAAs) and are chosen based on the genetic type of the virus, of which there are six. The stage of liver disease also is factored in.

Prescription Medications for HCV
Brand Name of Drug Active Ingredient(s) Approved for
Harvoni sofusbuvir + ledipasvir Genotype 1
Olysio simeprevir Genotype 1
Viekira Pak ombitasvir + paritaprevir + ritonavir co-packaged with dasabuvir Genotype 1
Daklinza daclatasvir Genotype 3
Technivie
ombitasvir + paritaprevir + ritonavir Genotype 4
Sovaldi sofusbuvir Genotypes 1, 2, 3 and 4
Zepatier grazoprevir + elbasvir Genotypes 1, 4 and 6
Epclusa sofosbuvir + velpatasvir
Genotypes 1, 2, 3, 4, 5 and 6

These DAAs are sometimes used in combination with the interferon and/or Copegus (ribavirin).

In addition, there are medications that can treat all six genotypes of HCV: Mavyret (glecaprevir/pibrentasvir) and Vosevi (sofosbuvir/velpatasvir/voxilaprevir).

Hepatitis D. HDV can only propagate in the presence of HBV. Chronic HDV infection tends to be more difficult to treat. While there are currently no FDA-approved therapeutic options, Intron A is sometimes prescribed.

Hepatitis E. Treatment options for HEV are limited, although there has been success with ribavirin.

Surgeries and Specialist-Driven Procedures

When a chronic hepatitis infection becomes so advance that major liver damage occurs, the only treatment option is a liver transplant. This is a complex surgical procedure that involves replacing a failing liver with that of a deceased donor. There are many risks involved, so this is considered a treatment of last resort—but it can be life-saving.

A Word From Verywell

Scientists continue to revolutionize treatment for viral hepatitis in two significant ways. One is improving on existing prescriptions. The other is developing new treatments, such as antiviral drugs that more efficiently prevent viral replication in liver cells. In addition, new therapies are taking advantage of the explosion of knowledge in genetic engineering. Given these inroads, the future of treating chronic hepatitis is bright.

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