Viral Hepatitis (cont.)
How is viral hepatitis treated?
Treatment of acute viral hepatitis and chronic viral hepatitis are different.
Treatment of acute viral hepatitis involves relieving symptoms and maintaining
adequate intake of fluids. Treatment of chronic viral hepatitis involves
medications to eradicate the virus and taking measures to prevent further liver
damage.
Acute hepatitis
In patients with acute viral hepatitis, the initial
treatment consists of relieving the symptoms of nausea, vomiting, and abdominal
pain. Careful attention should be given to medications which can have adverse
effects in patients with abnormal liver function. Only those medications that
are considered necessary should be administered since the impaired liver is not
able to eliminate drugs normally, and drugs may accumulate in the blood and
reach toxic levels. In addition, sedatives and "tranquilizers" are avoided
because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. The
patient must abstain from drinking alcohol since alcohol is toxic to the liver.
It occasionally is necessary to provide intravenous fluids to prevent
dehydration caused by vomiting. Patients with severe nausea and/or
vomiting may need to be hospitalized for treatment and intravenous fluids.
Chronic hepatitis
Treatment of chronic infection with hepatitis B and hepatitis C usually
involves medication or combinations of medications to eradicate the virus.
Doctors believe that in properly selected patients, successful eradication of
the viruses can stop progressive damage to the liver and prevent the development of cirrhosis, liver
failure, and liver cancer. Alcohol
aggravates liver damage in chronic hepatitis, and can cause more rapid
progression to cirrhosis. Therefore, patients with
chronic hepatitis should stop drinking alcohol. Smoking cigarettes also can
aggravate liver disease and should be stopped.
Medications for chronic hepatitis C infection include:
Medications for chronic hepatitis B infection include:
- injectable interferon
- oral lamivudine (Epivir)
- oral adefovir (Hepsera)
- oral entecavir (Baraclude)
Decisions regarding treatment of chronic hepatitis can be complex, and should be
directed by gastroenterologists or hepatologists (doctors specially trained in
treating diseases of the liver) for several reasons including:
- The diagnosis of chronic viral hepatitis may not be
straightforward. Sometimes a liver biopsy may have to be performed for
confirmation of liver damage. Doctors experienced in managing chronic liver
diseases must weigh the risk of liver biopsy against the potential benefits of the biopsy.
- Not all patients with chronic viral hepatitis are candidates for treatment.
Some patients need no treatment (since some patients with chronic hepatitis B
and C do not develop progressive liver damage or liver cancer).
- Medications for chronic infection with hepatitis B and hepatitis C are not always effective.
Prolonged treatment (6 months to years) often is necessary. Even with prolonged
treatment, rates of successful treatment (defined as complete and lasting
eradication of the virus) often are low (usually less than 80% and often around
50%).
- Some of the medications such as interferon and ribavirin can have serious
side effects, and doses may have to be reduced.
- There are several different strains of hepatitis C viruses with differing
susceptibilities to medications. For example, hepatitis C type 3 is more likely
to respond to interferon injections and ribavirin than type 1. Certain hepatitis
B strains are resistant to lamivudine but respond to adefovir or entecavir.
Please read the hepatitis B and
hepatitis C articles for more details in diagnosis and
treatment.
Fulminant hepatitis. Treatment of acute fulminant hepatitis should be done in
centers that can perform liver transplantation since acute fulminant hepatitis
has a high mortality without liver transplantation.
Next: How is viral hepatitis prevented? »
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