Published online Feb 7, 2022. doi: 10.3748/wjg.v28.i5.517
Peer-review started: April 30, 2021
First decision: June 30, 2021
Revised: July 14, 2021
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: February 7, 2022
Viral hepatitis is a significant health problem worldwide, associated with morbidity and mortality. Hepatitis B, C, D, and occasionally E viruses (HBV, HCV, HDV, and HEV) can evolve in chronic infections, whereas hepatitis A virus (HAV) frequently produces acute self-limiting hepatitis. In the last years, different studies have been performed to introduce new antiviral therapies. The most important goal in the treatment of viral hepatitis is to avoid chronic liver disease and complications. This review analyzes currently available therapies, in particular for viruses associated with chronic liver disease. The focus is especially on HBV and HCV therapies, investigating new drugs already introduced in clinical practice and clinical trials. We also describe new entry inhibitors, developed for the treatment of chronic HDV and HBV and currently available treatments for HEV. The last drugs introduced have shown important efficacy in HCV, with achievable target HCV elimination by 2030. Concurrently, renewed interest in curative HBV therapies has been registered; current nucleotide/ nucleoside analogs positively impact liver-related complications, ensuring high safety and tolerability. Novel approaches to HBV cure are based on new antivirals, targeting different steps of the HBV life cycle and immune modulators. The improved knowledge of the HDV life cycle has facilitated the development of some direct-acting agents, as bulevirtide, the first drug conditionally approved in Europe for HDV associated compensated liver disease. Further studies are required to identify a new therapeutic approach in hepatitis E, especially in immunosuppressed patients.
Core Tip: Viral hepatitis is a known worldwide health problem, with a risk of evolution in chronic liver disease. Novel therapies have shown increased efficacy in curing the hepatitis C virus (HCV), with the goal of HCV elimination by 2030. New concurrent interest in hepatitis B virus (HBV) curative therapies has been recently registered: New antivirals targeting different steps of HBV life cycle and immune modulators. In hepatitis D, the improved knowledge of the life cycle has facilitated the development of some direct-acting agents, more effective than interferon-based therapies. New studies are required to improve the treatment of hepatitis E.