Chronic Viral Hepatitis: Current Management and Future Directions

Abstract

The past decade has seen transformation in the strategies for identifying and managing viral hepatitis, most dramatically the transformation of hepatitis C virus from a mostly chronic affliction to a curable disease that is accessible to wide populations through direct‐acting antiviral therapies. More recently, shifting of hepatitis C virus burden to younger patients driven by intravenous drug use has shaped screening recommendations. Future work focusing on effective screening, linkage to care, treatment initiation, and post‐cure management will allow countries to work toward meeting goals of eliminating viral hepatitis as a major public health threat. Concurrently, hepatitis B virus has also seen advances in management using oral nucleos(t)ide therapies with high‐resistance barriers. However, virologic cure remains elusive in the setting of viral genetic persistence within the hepatocyte nucleus, even with suppressive antiviral therapy. Future directions include a refined definition of “cure,” new biomarkers, and development of therapies targeting multiple pathways in the viral pathogenic and replication pathway. Progress is additionally being made on the management of hepatitis D infection. This review summarizes the recent evolution in disease characteristics, associated affected population, and changes in our understanding of management for these infections. We also discuss future directions in the management of viral hepatitis, including discussion on issues related to management before and after antiviral therapy. Conclusion: We summarize recent advances in the identification and management of viral hepatitis, which hold the potential to markedly reduce disease burden and therefore associated liver‐related complications. However further work is needed to adequately identify and manage these diseases.

Prevalence of Hepatitis B Virus Markers in Patients with Autoimmune Inflammatory Rheumatic Diseases in Italy

“…Hepatitis B virus (HBV) infection still represents a relevant threat to global public health, considering that approximately million people are estimated to be affected worldwide [1]. Despite the availability, for over three decades, of an effective vaccine included in the infant vaccination schedule of most countries [2], approximately 2 billion people worldwide have come in contact with the virus [3].…”

Metal Nanoparticles: a Promising Treatment for Viral and Arboviral Infections

“…Globally, viral hepatitis has been confirmed as one of the leading causes of death, liver diseases, and disability. These liver diseases include cirrhosis, hepatocellular cancer, decompensated disease, and extrahepatic manifestations [136,137]. Currently, hepatitis C is curable if detected early with the aid of direct-acting antiviral therapies.…”

“…Significant advances in the management of hepatitis D infection are occurring [136]. However, a cure for viral hepatitis remains elusive, in the setting of viral genetic persistence within the hepatocyte nucleus, even with suppressive antiviral therapy [136]. Therefore, a possible cure and future therapeutic options must consider the targeting of multiple viral replication pathways in order to eliminate viral hepatitis as a public health threat [136].…”

HLA Alleles and KIR Genes in Romanian Patients with Chronic Hepatitis C

“…Currently worldwide around 71 million individuals are chronically infected with hepatitis C virus (HCV), some of them being under a significant risk of developing liver cirrhosis and hepatic tumors [1]. According to current estimates based on HCV serology, the prevalence of 4.5 -4.9% of HCV infection in the general population in Romania represents one of the highest figures in Europe [2,3].…”