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World J Gastroenterol. Jun 21, 2021; 27(23): 3249-3261
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3249
Update on the management and treatment of viral hepatitis
Patricia Holanda Almeida, Celso E L Matielo, Lilian A Curvelo, Rodrigo A Rocco, Guilherme Felga, Bianca Della Guardia, Yuri L Boteon
Patricia Holanda Almeida, Celso E L Matielo, Lilian A Curvelo, Rodrigo A Rocco, Guilherme Felga, Bianca Della Guardia, Yuri L Boteon, Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Yuri L Boteon, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-900, Brazil
Author contributions: Boteon YL designed the study; Almeida PH, Matielo CEL, Curvelo LA, Felga G, Rocco RA, and Della Guardia B performed the literature review and analysis; Boteon YL, Almeida PH, Matielo CEL, and Curvelo LA drafted the manuscript; Boteon YL reviewed the manuscript critically; all authors contributed to editing and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuri L Boteon, MD, PhD, Doctor, Professor, Surgeon, Liver Unit, Hospital Israelita Albert Einstein, Jardim Leonor, São Paulo 05652-900, Brazil. yurimed43@yahoo.com.br
Received: January 18, 2021
Peer-review started: January 18, 2021
First decision: February 23, 2021
Revised: March 11, 2021
Accepted: April 21, 2021
Article in press: April 21, 2021
Published online: June 21, 2021
Abstract

This review aims to summarize the current evidence on the treatment of viral hepatitis, focusing on its clinical management. Also, future treatment options and areas of potential research interest are detailed. PubMed and Scopus databases were searched for primary studies published within the last ten years. Keywords included hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus, hepatitis D virus (HDV), hepatitis E virus, and treatment. Outcomes reported in the studies were summarized, tabulated, and synthesized. Significant advances in viral hepatitis treatment were accomplished, such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A, hepatitis B, and hepatitis E vaccination. Drugs that cure hepatitis B, going beyond viral suppression, are so far unavailable; however, targeted antiviral drugs against HBV (immunomodulatory therapies and gene silencing technologies) are promising approaches to eradicating the virus. Ultimately, high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems. The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B, albeit further investigation is required. Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.

Keywords: Viral hepatitis, Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Hepatitis D virus, Hepatitis E virus

Core Tip: Viral hepatitis is a major global public health problem due to the risk of progression to chronic hepatitis, cirrhosis, and hepatocellular carcinoma development. The clinical management and treatment of these infections have evolved over the last decade. Even though remarkable achievements have been accomplished, such as the development of curative hepatitis C treatment, drugs that cure hepatitis B are still missing. In addition, programmes to enhance viral hepatitis testing and treatment together with broad vaccination coverage are required. In this review, we summarize the current evidence on the treatment of viral hepatitis and detail future treatment options, and potential areas of research.