Viral Hepatitis in Adults: Symptoms, Diagnosis, and Modern Treatment Methods

What is viral hepatitis?

Viral hepatitis is an inflammatory disease of the liver caused by various viruses. It is a serious global public health problem capable of leading to both acute and chronic conditions that significantly affect the quality and life expectancy of patients. There are several main types of hepatitis viruses, each with its own characteristics in transmission, disease progression, and treatment approaches.

Main types and symptoms of viral hepatitis

The most common causative agents of acute hepatitis are hepatitis A, B, and C viruses [3]. However, there are other significant types, such as the hepatitis E virus.

• Hepatitis A (HAV): Transmitted enterally, i.e., through contaminated food or water. It usually occurs in an acute form and does not lead to chronic liver disease [3]. In most cases, adults recover completely.
• Hepatitis B (HBV): Transmitted through blood and other biological fluids. In adults, about 95% of patients successfully recover from acute infection. However, if infection occurs in childhood, there is a high risk of developing chronic hepatitis B [3].
• Hepatitis C (HCV): Also transmitted through blood. It is known for its tendency to become chronic, which can lead to serious complications such as cirrhosis and liver cancer.
• Hepatitis E (HEV): Hepatitis E virus is considered a new epidemiological threat, especially for immunocompromised individuals, including transplant recipients and patients with rheumatic diseases [1]. The HEV3 genotype, common in Europe, is often associated with the consumption of undercooked wild boar or pork meat [1]. HEV usually causes an acute, self-limiting disease, but immunosuppressed patients may develop a chronic form [1].

Symptoms of acute viral hepatitis can range from complete absence to severe manifestations. Nonsuch as fatigue, nausea, vomiting, and abdominal pain are common. In more pronounced cases, jaundice (yellowing of the skin and sclera), dark urine, and pale stools may be observed. Chronic hepatitis is often asymptomatic for many years until significant liver damage develops.

Diagnosis and potential complications

Diagnosis of viral hepatitis is based on a thorough medical history, including risk factors, and serological tests to detect specific antibodies or viral antigens [3]. In cases where serological tests are negative, other causes of acute hepatitis must be excluded, such as infections caused by Epstein-Barr virus or cytomegalovirus, drug reactions, or autoimmune hepatitis [3].

Viral hepatitis can lead to serious complications:

• Acute liver failure: A rare but extremely dangerous complication of acute viral hepatitis. Signs requiring immediate admission to a liver transplantation unit include persistent vomiting, significantly prolonged prothrombin time, and confusion [3].
• Liver cirrhosis: Develops with prolonged chronic inflammation and liver damage, which can be the outcome of chronic hepatitis B or C. Cirrhosis, in turn, can lead to complications such as gastrointestinal bleeding, for example, due to portal hypertensive gastropathy or gastric antral vascular ectasia (GAVE), as shown in a case of a patient with liver cirrhosis [5].

Modern approaches to the treatment of viral hepatitis

The treatment of viral hepatitis has advanced significantly in recent decades, especially regarding hepatitis C and B.

Treatment of hepatitis C

The advent of direct-acting antivirals (DAAs) has revolutionized the treatment of chronic hepatitis C, providing high cure rates. The combination of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is primarily positioned in international guidelines as "rescue" therapy for patients who have previously failed treatment [2]. However, in some countries, such as Turkey, this regimen is uniquely used as a first-line therapy for treatment-naive patients [2]. Studies show that SOF/VEL/VOX is effective and safe for both treatment-naive and treatment-experienced patients with chronic hepatitis C without cirrhosis [2].

It is important to note that chemotherapy can affect treatment efficacy. For example, a 67-year-old female patient with follicular lymphoma receiving bendamustine-rituximab chemotherapy developed hepatitis C viremia, and a 12-week course of sofosbuvir/velpatasvir did not lead to a sustained virological response. This highlights the possibility that chemotherapy may contribute to treatment failure despite adequate antiviral therapy [6].

Treatment of hepatitis B

Current treatment guidelines for chronic hepatitis B (CHB) are constantly expanding the indications for therapy, including age over 30 years as an important criterion [8]. The mainstay of treatment is nucleos(t)ide analogues (NAs). A study involving 808 treatment-naive CHB patients aged over 30 with high baseline viral load showed that the overall virological response rate to NA monotherapy was 90.0% at 48 weeks [8].

Treatment of hepatitis E

In most cases, acute hepatitis E is self-limiting and does not require specific treatment [1]. However, in immunocompromised patients who develop chronic infection, treatment is challenging and requires an individualized approach [1].

Prevention and risk groups

Prevention of viral hepatitis plays a key role in combating this disease:

• Vaccination: Highly effective and safe vaccines are available for hepatitis A and B, serving as an essential prevention tool [3].
• Hygiene and safety: Observing hygiene rules, safe blood handling, and using sterile instruments help prevent virus transmission.

Special attention should be paid to risk groups. Immunocompromised patients, such as those after organ transplantation, with rheumatic diseases, or oncological diseases, are more susceptible to the development of chronic forms of hepatitis (e.g., HEV) and reactivation of other viral infections [1, 4]. Reactivation of viral infections, including hepatitis B virus, is common in patients with solid tumors or hematological malignancies due to immunosuppression caused by anti-cancer treatment [4]. In such cases, antiviral prophylaxis can be effective in preventing virus reactivation [4].

Conclusion

Viral hepatitis is a complex disease requiring a careful approach to diagnosis and treatment. Modern advances in medicine allow for effective combat against most forms of hepatitis, preventing their chronicity and the development of serious complications. Early diagnosis, adequate therapy, and the widespread use of preventive measures, such as vaccination, are key to improving patient prognosis and quality of life.

References

1. Hepatitis E virus infection: considerations for immunologists and rheumatologists. https://pubmed.ncbi.nlm.nih.gov/42484649/
2. Real-world efficacy and safety of sofosbuvir/velpatasvir/voxilaprevir in treatment-naive and treatment-experienced chronic hepatitis c patients: a single-center study. https://pubmed.ncbi.nlm.nih.gov/42698083/
3. Acute viral hepatitis. https://pubmed.ncbi.nlm.nih.gov/9640308/
4. Antiviral prophylaxis in patients with solid tumours and haematological malignancies--update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). https://pubmed.ncbi.nlm.nih.gov/26193852/
5. Gastric Antral Vascular Ectasia as an Uncommon Cause of Upper Gastrointestinal Bleeding: A Case Report. https://pubmed.ncbi.nlm.nih.gov/42434665/
6. Persistent Hepatitis C Viremia Following Sofosbuvir/Velpatasvir During Bendamustine-Rituximab Therapy for Follicular Lymphoma. https://pubmed.ncbi.nlm.nih.gov/42787531/
7. Virologic Response to Antiviral Therapy in Chronic Hepatitis B Patients With High Viral Load: A Real-World Cohort Study. https://pubmed.ncbi.nlm.nih.gov/42635463/

The information presented in this article is for reference purposes only and cannot replace professional medical advice. Always consult a specialist for the diagnosis and treatment of diseases.