Treatment of acute hepatitis

In majority of immunocompetent adults, acute HBV is a self-limiting condition (1).

Main treatment goal is to:

• prevent the risk of acute or subacute liver failure
• improve the quality of life by shortening the duration of the disease associated symptoms
• lowering the risk of chronicity (2)

Treatment has little effect on altering the course and is mainly supportive.

• antiviral therapy is not indicated in the most patients with acute hepatitis B, but may be indicated in certain subgroups of patients e.g. – in fulminant hepatitis B, those who are immunocompromised etc. (1)

Bed rest is preferable but is less necessary in young, previously fit persons.

In acute hepatitis B, gammaglobulin is advocated and this should help limit the disease.

Admission to hospital is recommended in the following patients:

• patients who have coagulopathy, are deeply jaundiced, or are encephalopathic
• patients who are older, have significant co-morbidities, or cannot tolerate oral intake (1)

A low-fat, high carbohydrate diet may be advised. It is popular primarily because it is highly palatable.

Measures should be taken to prevent transmission, such as careful attention to hand washing and personal hygiene. Patients are infectious for 2-3 days before and about a week after the development of jaundice.

Alcohol and potentially hepatotoxic drugs should be withdrawn, preferably for up to one year after the attack.

In fulminant acute liver failure, liver transplantation may be indicated, this however is a contentious issue. Acute liver failure has a high mortality, but the indications and timing of transplantation have yet to be determined.

Reference:

• (1) Jindal A, Kumar M, Sarin SK. Management of acute hepatitis B and reactivation of hepatitis B. Liver Int. 2013;33 Suppl 1:164-75.
• (2) European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398