How Viral Hepatitis Is Treated

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Treatment of viral hepatitis depends on whether the infection is acute (short-lived) or chronic. Acute hepatitis (typically caused by hepatitis A, E, or sometimes C) often is asymptomatic or merely brings on mild flu-like symptoms that can be eased with rest and fluids. Chronic hepatitis, on the other hand, must be treated with prescription medications targeted to the type of hepatitis virus responsible for the infection. Otherwise, it can lead to devastating consequences, including cirrhosis of the liver or even cancer (hepatocellular carcinoma). If medication fails to prevent severe liver damage (or if a hepatitis infection isn't discovered until damage occurs), a liver transplant usually is necessary.

Prescriptions

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

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

Hepatitis B (HBV): 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.

At present, there are five prescription drugs for treating chronic HBV approved by the U.S. Food and Drug Administration (FDA): Interferon and four other antiviral medications. Another, Tyzeka (telbivudine), was discontinued in 2016.

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 of 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.
  • Hepsera (adefovir): A medication in a class of drugs called nucleotide analogs. Hepsera is a tablet that is taken once a day.
  • Baraclude (entecavir): An antiviral in a class of drugs called reverse transcriptase inhibitors. It's available as either a tablet or an orange-flavored liquid and usually is taken once a day for a year.
  • Viread (tenofovir): Viread is in a class of medications called nucleoside reverse transcriptase inhibitors. It comes as either a tablet that should be taken without food or as a powder to be stirred into something soft like yogurt or applesauce.
  • Epivir-HBV (lamivudine): This antiviral originally was developed and sold as Epivir to treat infection caused by human immunodeficiency virus (HIV). Although not a first-line treatment for HBV, for certain people Epivir-HBV may work well to prevent the virus from replicating. It's relatively inexpensive and comes as either a pill or a liquid: both are taken once a day for one year, with or without food.

Hepatitis C (HCV): The drugs approved by the FDA to treat a hepatitis C infection are newer generation direct-acting antivirals (DAAs). Two of these can treat all six genotypes of the HCV virus. The others are used only to treat specific genotypes. A doctor will also factor in the stage of liver disease when developing a treatment protocol for a patient.

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
Vosevi sofosbuvir + velpatasvir + vixukaorevir Genotypes 1, 2, 3, 4, 5, and 6

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

Hepatitis D (HDV): 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 for HDV, Intron A is sometimes prescribed.

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

Surgery

When a chronic hepatitis infection becomes so advanced 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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