Management of Acute Viral Hepatitis
The management of acute viral hepatitis is primarily supportive care, as most cases are self-limited and will resolve without specific antiviral therapy. 1
General Management Principles
- Supportive care is the mainstay of treatment for most types of acute viral hepatitis (A, B, C, E) 1
- Avoid hepatotoxic medications and abstain from alcohol during the acute phase 2
- Maintain adequate hydration and nutrition with a high-calorie diet if tolerated 2
- Monitor for signs of acute liver failure, which is an uncommon but serious complication 1
Specific Management by Viral Type
Hepatitis A
- Purely supportive care is recommended as it is typically self-limited 2
- No specific antiviral therapy has proven effective 1
- Hospitalization may be necessary for patients with severe symptoms, dehydration, or altered mental status 2
Hepatitis B
- For uncomplicated acute hepatitis B, supportive care is the standard approach 1
- Nucleoside analogs (such as lamivudine or tenofovir) may be considered in patients with acute hepatitis B, though controlled trials are limited 1
- For patients with HBsAg positivity who are undergoing chemotherapy or immunosuppression, prophylactic nucleoside analog therapy should be given and continued for 6 months after completion of immunosuppressive therapy to prevent reactivation 1
Hepatitis C
- For acute hepatitis C, pegylated interferon-α monotherapy (pegylated IFN-α2a, 180 μg/week or pegylated IFN-α2b, 1.5 μg/kg/week, for 24 weeks) has shown high sustained virologic response rates (>90%) 1
- Consider monitoring HCV RNA levels every 4 weeks and initiating treatment for those still positive at 12 weeks after initial presentation 1
- Newer direct-acting antivirals (DAAs) like glecaprevir/pibrentasvir are now approved for chronic HCV but their role in acute infection is still evolving 3
Hepatitis E
- Generally self-limiting in immunocompetent individuals and requires only supportive care 4
- Ribavirin may be considered for chronic hepatitis E in immunocompromised patients 4, 5
- Pregnant women with hepatitis E require close monitoring as they are at higher risk for severe outcomes, especially with genotype 1 1
Herpes Virus Hepatitis
- Acyclovir should be initiated promptly for suspected or documented cases of herpes virus hepatitis 1
- Patients with herpes virus or varicella zoster causing acute liver failure should be immediately placed on the liver transplant list 1
Monitoring and Follow-up
- Regular assessment of liver function tests to monitor disease progression 1
- For patients who do not recover spontaneously, follow-up testing for chronic infection is essential 1
- Untreated patients with chronic hepatitis should be assessed every 1-2 years with non-invasive methods 1
Special Considerations
- Pregnancy: Hepatitis E is particularly concerning in pregnant women, especially in the second and third trimesters, with higher rates of fulminant hepatic failure 1
- Immunocompromised patients: May have atypical presentations and are at higher risk for chronic infection, particularly with HBV and HEV 1
- Pre-existing liver disease: Patients with underlying liver disease require closer monitoring as they are at higher risk for decompensation 4
Prevention
- Test all patients for evidence of current or prior HBV infection before initiating treatment for HCV to prevent HBV reactivation 3
- Vaccination remains the most effective prevention strategy for hepatitis A and B 6
- Post-exposure prophylaxis should be considered for close contacts of infected individuals 7