Antiviral Drugs For Hepatitis

  • Duyen NguyenMaster in Science - MSci Human Biology, University of Birmingham

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Overview

Hepatitis refers to inflammation of the liver. This inflammation can occur because of viruses, chemicals, drugs, alcohol, genetic issues, or because your immune system wrongly attacks the liver (autoimmune hepatitis). Some cases are short-term (acute), whilst others are long-lasting conditions (chronic) with mild symptoms and ongoing liver damage. In this article, we will discuss the antiviral drugs available to treat the different types of hepatitis. 

Types of hepatitis

Hepatitis comes in various types. Some go away on their own, while others, if chronic, can lead to liver scarring (cirrhosis), loss of function, and even liver cancer.1 

Hepatitis A 

This type of hepatitis is often caused by contaminated food or drink. It usually clears within 3 to 6 months. Vaccination is recommended for those with a high risk of catching the virus, this includes travellers to certain regions where hepatitis A is common.

Hepatitis B

Hepatitis B spreads through infected blood, from mother to child, or through unprotected sex and drug use. Most adults recover fully, but childhood infections can lead to chronic hepatitis B, which is treatable with antiviral medications.

Hepatitis C

Hepatitis C spreads through blood contact, commonly from sharing needles. It often shows no symptoms but can lead to chronic hepatitis C, and is treatable with antiviral medications. No vaccine is currently available.

Hepatitis D

Hepatitis D occurs in those already infected with hepatitis B. It is spread through blood or sexual contact. This form of hepatitis can increase your risk of more serious complications, but the hepatitis B vaccine can offer some protection.

Hepatitis E

Hepatitis E is commonly caused by consuming undercooked pork or contaminated water. It is usually mild and short-term. Currently, no vaccine is available.

Alcoholic hepatitis

This form of hepatitis is caused by excessive alcohol consumption over many years. This condition is often symptomless but can lead to severe complications. To prevent your condition from worsening, it is advised to stop drinking alcohol (abstinence). Abstinence is important for enabling your liver to recover and reducing your risk of developing complications such as cirrhosis, liver cancer, or liver failure

Autoimmune hepatitis

This form of hepatitis is rare, where the immune system attacks the liver, leading to damage. Treatment involves medicines to suppress the immune system. The cause is unclear and prevention methods are unknown.

Risk factors

Different types of hepatitis have various ways of spreading and risk factors that make you more susceptible to developing the condition.

Type of HepatitisRisk factorsTransmission
Hepatitis A-Travelling to a country where hepatitis A is common
-Poor sanitation
-Unclean (sewage-contaminated or inadequately-treated water)
-Living in the same household or being a sexual partner of someone with hepatitis A 
-Sex between men
-Use of injection drugs (i.e., illegal recreational drugs and anabolic steroids)
The primary transmission route is faecal-oral (i.e., transmission through contaminated food or water)Sexual transmission
Hepatitis B-Travelling to a country where hepatitis B is endemic
-Use of injection drugs 
-Healthcare workers
-Being a sexual partner of someone with hepatitis B
-Blood-to-blood contact
-Sexual transmission
-Passed from infected pregnant women to their child
Hepatitis C-Use of injection drugs 

Less common risk factors include:

-Unprotected sex 
-Tattooing and body piercing
-Sharing toothbrushes or sharp objects (e.g., scissors or razors)
-Blood-to-blood contact
-Sexual transmission
-Passed from infected pregnant women to their child
Hepatitis D-Only affects people already infected with the Hepatitis B virus (HBV)
-Use of injection drugs
-Coinfected with human immunodeficiency virus (HIV) and HBV
-Blood-to-blood contact
-Sexual transmission
Hepatitis E-Poor sanitation
-Unclean (sewage-contaminated or inadequately-treated water)
-Consumption of raw or undercooked pork, shellfish, offal or game meat (e.g., venison and wild boar meat)
-Weakened immune system
-Faecal-oral transmission

Antiviral drugs for hepatitis

Specific antiviral drugs are recommended based on the type of hepatitis:

Hepatitis A

Currently, there is no specific antiviral treatment for hepatitis A. Your body is usually capable of clearing the virus on its own. Recovery can take from 3 to 6 months. 

Your healthcare provider may recommend medicines to alleviate symptoms, such as painkillers. 

Hepatitis B

Recommended antiviral agents include:

  • Entecavir
  • Tenofovir disoproxil fumarate
  • Tenofovir alafenamide

These drugs inhibit hepatitis B virus replication, reducing the viral load and slowing liver disease progression.

Hepatitis C

Direct-acting antivirals (DAAs) like:

  • Sofosbuvir
  • Ledipasvir
  • Simeprevir 

These drugs target specific viral proteins, disrupting replication and infection processes. The choice depends on the virus genotype, treatment history, and cirrhosis presence.4 

Hepatitis D

Occurring in those co-infected with hepatitis B, pegylated interferon-alpha is the current treatment.

Hepatitis E

No specific antiviral drugs are approved, but ribavirin is sometimes used off-label in severe cases or immunocompromised patients.

It's crucial to individualise antiviral therapy based on the patient's condition, potential drug interactions, and side effects. The decision to start treatment should involve a thorough discussion between the patient and the healthcare provider.

Side effects and contraindications

Using antiviral drugs like interferon alfa, ribavirin, and direct-acting antivirals (DAAs) such as simeprevir and sofosbuvir for hepatitis can lead to different effects and things to be cautious about.5

Interferon alfa

  • Flu-like symptoms
  • Depression
  • Irritability
  • Cytopenia

Ribavirin

  • Hemolytic anaemia
  • Pruritus
  • Rash

This drug is not suitable during pregnancy due to potential harm to the developing baby.

Direct-acting antivirals (DAAs)

These generally cause fewer side effects compared to interferon-based treatments.

  • Simeprevir - common side effects include rash, pruritus, and sensitivity to sunlight
  • Sofosbuvir - usually well-tolerated but may lead to fatigue, headache, and insomnia4 

Cautions involve avoiding these drugs in severe liver disease, certain health conditions, and during pregnancy for specific medications. It's crucial to tailor the choice of antiviral therapy considering factors like the hepatitis virus type, liver disease stage, potential drug interactions, existing health conditions, and the chance of pregnancy.

Lifestyle tips for hepatitis patients

To minimise the risk of disease progression and transmission, individuals with hepatitis should consider the following:6

Avoid alcohol

Avoiding alcohol is crucial because it can speed up liver damage in hepatitis patients.

Be cautious with medications

Some medications can worsen liver damage, so it's essential to consult with a healthcare provider before starting any new medication.

Get vaccinated

If you have hepatitis B or C, it's recommended to get vaccinated against hepatitis A and B (if not already immune) to prevent further liver damage.

Stay safe

Steer clear of sharing personal items like razors or toothbrushes that may have blood on them. Practise safe sex to prevent transmission.

Eat healthy, exercise regularly

Maintaining a healthy weight through a balanced diet and regular exercise can help prevent fatty liver disease, which can add to liver damage.

Regular health check-ins

Keep up with regular check-ups with your healthcare provider to monitor the progression of the disease and start treatment when needed.

Say no to illicit drugs

Avoiding illicit drug use, especially injection drugs, is vital since it's a significant risk factor for hepatitis C transmission. Seek counselling and addiction treatment resources if needed. 

Summary 

  • Hepatitis involves liver inflammation from various causes, including viruses, chemicals, drugs, alcohol, genetic issues, or autoimmune reactions
  • Treatment involves specific antiviral drugs tailored to the hepatitis type, like entecavir and tenofovir for hepatitis B
  • Different hepatitis types have varied transmission risks, such as blood contact, sexual transmission, and contaminated food or water
  • Antiviral drugs may cause side effects like flu-like symptoms, depression, and rash, and caution is needed in specific health conditions and during pregnancy
  • Patients should adopt a lifestyle that includes avoiding alcohol, consulting healthcare providers before new medications, getting vaccinated, practising safe habits, and maintaining a healthy lifestyle with regular check-ups

References 

  1.  Mehta P, Reddivari AKR. Hepatitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK554549/.
  2. Zarrin A, Akhondi H. Viral Hepatitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556029/.
  3. Tripathi N, Mousa OY. Hepatitis B. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK555945/.
  4. Lanini S, Ustianowski A, Pisapia R, Zumla A, Ippolito G. Viral Hepatitis: Etiology, Epidemiology, Transmission, Diagnostics, Treatment, and Prevention. Infect Dis Clin North Am. 2019; 33(4):1045–62.
  5. Iorio N, John S. Hepatitis A. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK459290/.
  6. Odenwald MA, Paul S. Viral hepatitis: Past, present, and future. World J Gastroenterol. 2022; 28(14):1405–29.

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