Treatment
Hepatitis A
Hepatitis A resolves in the majority of cases without any specific treatment.
Hepatitis B
Acute infection
No specific treatment is needed in uncomplicated acute cases, which recover spontaneously. Some people with more severe symptoms may be admitted to hospital to promote rest. A high carbohydrate, low fat diet is recommended. Troublesome itching due to jaundice can be treated with colestyramine. Consumption of alcohol should be avoided for up to a year.
Chronic infection
Drug treatment of chronic hepatitis B is initiated and monitored by specialists. Its aim is to improve immunity to the persistent virus. The following drugs may be used:
Peginterferon alfa-2a Interferon Adefovir dipivoxil Lamivudine |
given by injection given by injection 3 times weekly, usually for 4 months given orally once a day given orally once a day |
These types of drugs have a number of potentially serious side effects and require close monitoring. The interferons may cause anorexia, nausea, flu-like symptoms and lethargy. More severe side effects may include depression including suicidal behaviour. The severity of the side effects may result in some people being unable to complete the treatment course.
Some people with chronic hepatitis B may be considered for liver transplantation.
Prevention
Hepatitis B can be prevented by vaccination. In areas of the world with high incidence universal vaccination of infants is undertaken. In the UK babies born to infected mothers, health care workers, prison staff and other people at high risk of infection are offered vaccination.
Health care workers who sustain needle stick injuries in the course of their work may also be offered specific vaccination to reduce the likelihood of infection.
Hepatitis C
Acute infection
There is no specific treatment for the acute infection. People are advised to rest, avoid alcohol and take a low fat, high carbohydrate diet.
Chronic infection
People with chronic infection are monitored with blood tests, liver scans and liver biopsy to assess the severity of the condition and determine when specific drug therapy should be started.
Those with progressive disease of moderate to severe severity and with cirrhosis are considered suitable for treatment. Mild disease does not respond well to current treatment regimes. The aim of drug treatment is to clear the virus form the body and to slow the progression of pathological changes in the liver culminating in cirrhosis. It is initiated and monitored in a specialist liver clinic.
The drugs used are:
Interferon alpha Peginterferon alpha Ribavirin |
given by injection. given weekly by subcutaneous injection. an oral drug given daily. |
The preferred regime for most cases is ribavirin given in combination with peginterferon alpha.
The treatment length can be between 12 - 48 weeks and is dictated by the type of hepatitis C genotype(s) with which the person is infected, the severity of the infection and the response to treatment. Overall treatment is judged to be successful in up to 55% of people.
Peginterferon alpha has a number of side effects including anorexia, nausea, flu-like symptoms and lethargy. More severe side effects may include depression including suicidal behaviour. Ribavirin may cause anaemia. The severity of the side effects may result in some people being unable to complete the treatment course.
Late complications such as cirrhosis and hepato-cellular carcinoma may be treated with liver transplantation. However recurrence of the virus infection after transplantation is a significant problem.
