Viral Hepatitis: Treatment

Initial treatment includes supportive fluids and electrolyte management, monitoring of nutrition status, and avoidance of hepatotoxic substances (eg, alcohol, acetaminophen, statins). Abstinence from alcohol is mandatory, as noted below.

In addition to the above measures, treatment targets the underlying hepatitis virus as follows:

• Hepatitis A: Most cases are self–limited. Hepatitis A immunoglobin may be given.  
• Hepatitis B: Hepatitis B immunoglobin is given for postexposure prophylaxis. Chronic hepatitis B is treated with interferon alpha. Lamivudine and ribavirin may also be used.
• Hepatitis C: Chronic disease is treated with interferon alpha and ribavirin for 6 months to 1 year.
• Hepatitis D: Interferon alpha is given for at least 1 year.
• Hepatitis E: The disease is usually self–limited. Prevention via clean water sources is essential.

Vaccination is available for hepatitis A and hepatitis B. All patients with chronic hepatitis B should be vaccinated for hepatitis A, and patients with hepatitis C should be vaccinated for both hepatitis A and hepatitis B.

Acute complications of liver failure are treated as necessary (eg, lactulose to reduce serum ammonia concentration in patients with hepatic encephalopathy, fresh–frozen plasma for coagulopathy).

End–stage liver failure may require liver transplantation.