Update on the management and treatment of viral hepatitis

Table 1 Current clinical management of viral hepatitis and areas of development for future therapies

Type	Current management	Areas of development
Hepatitis A	No specific drugs against HAV infection are available so far; thus treatment consists of supportive care; Prevention of HAV infection includes vaccination, immune globulin, and attention to hygienic practices	Public health campaigns to promote the prevention of hepatitis A; Raise awareness of indications for hepatitis A vaccination
Hepatitis B	Entecavir, tenofovir disoproxil fumarate, tenofovir alafenamide fumarate, and pegylated interferon alpha are currently the first-line anti-HBV agents recommended for chronic hepatitis B treatment; Prevention of HBV infection is focused on vaccination;	Elimination or inactivation of HBV cccDNA is the major focus of HBV research; Targeted therapies to HBV (immunomodulatory therapies and gene silencing technologies are promising approaches); Need to increase hepatitis B vaccination coverage
Hepatitis C	Multiple combinations of direct-acting antivirals with high pangenotypic efficacy result in high sustained virological response rates, excellent safety, and good tolerance, even for patients with advanced fibrosis and cirrhosis;	Increase awareness of the disease, develop screening programmes; Optimization of direct-acting antivirals use; Attention to specific care needs to be taken in the post-treatment phase
Hepatitis D	There are no satisfactory drugs for this disease; Pegylated interferon alpha recommended for the treatment of chronic HDV infection, although limited by poor tolerance is usually avoided in patients with cirrhosis, active autoimmune disease, or certain psychiatric disorders	Further research on novel targeted HDV antiviral medications is necessary due to the lack of effective therapeutic options
Hepatitis E	There is no recommended treatment for acute HEV infections because it is usually self-limiting with spontaneous HEV clearance	Ribavirin is suggested to be an effective treatment for immunocompetent patients with severe hepatitis E; New anti-HEV drugs are under investigation; T cell therapy may be an alternative to conventional medicines; Vaccines to combat HEV have been developed and tested

HAV: Hepatitis A virus; HBV: Hepatitis B virus; cccDNA: Covalently closed circular deoxyribonucleic acid; HDV: Hepatitis D virus; HEV: Hepatitis E virus.