Copyright
©The Author(s) 2021.
World J Meta-Anal. Apr 28, 2021; 9(2): 139-152
Published online Apr 28, 2021. doi: 10.13105/wjma.v9.i2.139
Published online Apr 28, 2021. doi: 10.13105/wjma.v9.i2.139
Table 1 Comparison of hepatotropic viruses hepatitis A-E
Hepatitis | A | B | C | D | E |
Viral structure | Naked, ssRNA (Picornavirus) | Envelope, dsDNA (Hepadnavirus) | Envelope, ssRNA (Flavivirus) | Envelope, ssRNA (-ve) (Deltavirus) | Naked, ssRNA (Hepevirus) |
Transmission | Faecal-oral | Parenteral, sexual | Parenteral, sexual | Parenteral, sexual | Faecal-oral |
Incidence | 1.4 million | > 250 million[88] | > 80 million | About 12 million (prevalence)[89] | 20 million |
Chronic infection | No | About 90% of infants infected; about 2%-6% adult infected | 70% (55%-85%) | < 5% of those infected with HBV, > 80% of superinfection)[90] | No (very rarely in immunosuppressed adults)[91] |
Other disease associations | None | HCC, cirrhosis | HCC, cirrhosis | Cirrhosis, fulminant hepatitis | None (cirrhosis in chronic HEV infection) |
Treatment | Supportive | Viral suppressive therapy (see criteria for commencement of treatment below) | Eradication therapy DAA (gold standard) | PEG-IFN (sparse data) | Supportive |
Table 2 Diagnosing hepatitis A-E
Hepatitis | Serological testing | Molecular testing (via PCR), quantitative |
A | Anti-HAV IgM (acute); Anti-HAV IgG (previous infection, vaccination); Note incubation period of 28 d[92] | HAV RNA |
B | Anti-HBc (contact with HBV infection); HBsAg (current infection) appears 1-3 wk post exposure, duration > 24 wk denotes chronicity; Anti-HBS (vaccination, cleared HBV infection); HBeAg (high replication phase (> 10000 IU/mL); Anti-HBe (low replication phase (< 10000 IU/mL); Note incubation 90 d (ranges 45-160 d); Window period 1: first about 8 d of infection; Window period 2: clearance of HBsAg during this period Anti-HBc IgM is detectable[93] | HBV DNA |
C | Anti-HCV: Note incubation 6-7 wk (ranges 2 wk to 6 mo)[93] | HCV RNA |
D | Anti- HDV IgG | HDV RNA |
E | Anti-HEV IgM and IgG and IgA | HEV RNA |
Table 3 European Association for the Study of the Liver 2017 clinical practice guidelines on the management of hepatitis B virus infection[12]
Clinical practice guidelines |
All patients with HBeAg-positive or -negative chronic hepatitis B, defined by HBV DNA (2000 IU/mL, ALT) upper limit of normal (ULN) and/or at least moderate liver necroinflammation or fibrosis, should be treated (Evidence level I, grade of recommendation 1) |
Patients with compensated or decompensated cirrhosis need treatment, with any detectable HBV DNA level and regardless of ALT levels (Evidence level I, grade of recommendation 1) |
Patients with HBV DNA (20000 IU/mL, and ALT) 2 × ULN should start treatment regardless of fibrosis degree (Evidence level II-2, grade of recommendation 1) |
Patients with HBeAg-positive chronic HBV infection, defined by persistently normal ALT and high HBV DNA levels, may be treated if they are older than 30 years regardless of the severity of liver histological lesions (Evidence level III, grade of recommendation 2) |
Patients with HBeAg-positive or HBeAg-negative chronic HBV infection and family history of HCC or cirrhosis and extra-hepatic manifestations can be treated even if typical treatment indications are not fulfilled (Evidence level III, grade of recommendation 2) |
Table 4 Comparing pegylated-interferon therapy to nucelos(t)ide analogues therapy
PEG-IFN | NA | |
Route of administration | Subcutaneous | Oral |
Length of treatment | 48 wk | Long-term in chronic HBV (stopping may be considered in some cases[13]); 8-16 wk in HCV |
Contraindications | Many (i.e., decompensated disease, comorbidities) | None (dose adjustment according to eGFR) |
Tolerance | Inferior tolerability | Excellent tolerance |
Side effects | Significant adverse events (psychiatric, neurologic, endocrinological) | Renal impairment (some DAA)[12] |
SVR in HCV | 40%-75%[94,95] | > 90%[46] |
Efficacy in chronic HBV | > 30% HBeAg loss; 3%-5% HBsAg loss[96] | > 11%-18% eAg loss (lower rate of HBeAg seroconversion); Very low HBsAg loss[97] |
Cost | Expensive | Expensive when given long-term (i.e., chronic HBV infection)[98] |
Resistance | No | Yes |
Table 5 First-line recommended direct-acting antiviral therapies for hepatitis C patients
Genotype | 1 | 2 | 3 | 4 | 5/6 |
DAA schedule (non-cirrhotic) | Sofosbuvir/Ledipasvir; Or Glecaprevir/Pibrentasvir | Sofosbuvir/Velpatasvir | Sofosbuvir/Velpatasvir | Sofosbuvir/Ledipasvir | Sofosbuvir/Ledipasvir |
Duration | 8-12 wk | 12 wk | 12 wk | 12 wk | 12 wk |
DAA schedule (cirrhotic) | Sofosbuvir/Ledipasvir | Sofosbuvir/Velpatasvir | Glecaprevir/Pibrentasvir | Sofosbuvir/Ledipasvir | Sofosbuvir/Ledipasvir |
Duration | 12 wk | 12 wk | 8-16 wk | 12 wk | 12 wk |
- Citation: Fagan O, Armstrong P, Merwe KVD, Crosnoi D, Steele C, Sopena-Falco J, Parihar V. Viral hepatitis: A brief introduction, review of management, advances and challenges. World J Meta-Anal 2021; 9(2): 139-152
- URL: https://www.wjgnet.com/2308-3840/full/v9/i2/139.htm
- DOI: https://dx.doi.org/10.13105/wjma.v9.i2.139