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Content Update

Feb. 21, 2020

Simplified Treatment for Hepatitis C Virus (HCV) Infection: Since 2011, the availability of direct-acting antivirals (DAAs) has dramatically improved outcomes associated with HCV infection, with cure rates now approaching 100%. Over the past 5 years, pangenotypic therapies (ie, those effective against all 6 genotypes) and medications with a benign adverse effect profile have been approved and marketed. In December 2019, the AASLD and IDSA released updated guidelines recommending protocol-based simplified treatment with the intent to expand HCV treatment access. Treatment-naive patients who meet prespecified criteria may qualify for the simplified treatment approach. Two pangenotypic DAA options are recommended: 1) glecaprivir/pibrentasvir (Mavyret) for 8 weeks and 2) sofosbuvir/velpatasivir (Epclusa) for 12 weeks. While these recommendations simplify therapy with a goal to increase medication access, the importance of individualized patient evaluation remains.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Differentiate the five types of viral hepatitis by epidemiology, etiology, pathophysiology, clinical presentation, and natural history.

  2. Identify modes of transmission and risk factors among the major types of viral hepatitis.

  3. Evaluate hepatic serologies to understand how the type of hepatitis is diagnosed.

  4. Create treatment goals for a patient infected with viral hepatitis.

  5. Recommend appropriate pharmacotherapy for prevention of viral hepatitis.

  6. Develop a care plan for treatment of chronic viral hepatitis.

  7. Formulate a monitoring plan to assess adverse effects of pharmacotherapy for viral hepatitis.

INTRODUCTION

The most common types of viral hepatitis include hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV). Acute hepatitis may be associated with all five types of hepatitis and rarely exceeds 6 months in duration. Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. image Chronic viral hepatitis may lead to the development of cirrhosis and may result in end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). Complications of ESLD include ascites, edema, hepatic encephalopathy, infections (eg, spontaneous bacterial peritonitis), hepatorenal syndrome, and esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD and HCC.

Viral hepatitis may occur at any age and is one of the most common causes of liver disease in the world. The true prevalence and incidence may be underreported because most patients are asymptomatic. The epidemiology, etiology, and pathogenesis vary depending on the type of hepatitis and are considered separately below.

EPIDEMIOLOGY AND ETIOLOGY

Hepatitis A (HAV)

HAV affects 1.4 million people yearly worldwide.1 The prevalence is highest in economically challenged and underdeveloped countries, including Central and South America, Africa, the Middle East, Asia, and the Western Pacific.2 The numbers of acute HAV infections and hospitalizations have decreased since the introduction of the HAV ...

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