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Hepatitis A usually clears up on its own and does not require treatment. Patients should make sure to get plenty of rest and avoid drinking any alcohol until they are fully recovered.
There are no medications for treating acute hepatitis B. Doctors usually recommend that patients get plenty of bed rest, drink plenty of fluids, and get adequate nutrition.
Although there is no cure for chronic hepatitis B, many types of antiviral drugs are available to treat it. Not all patients with chronic hepatitis B require medication. Patients should seek the advice of an internal medicine doctor or specialist (a gastroenterologist, hepatologist, or infectious disease doctor) who has experience treating hepatitis B.
Patients with chronic hepatitis B should receive regular monitoring to evaluate any signs of disease progression, liver damage, or liver cancer. It is also important that patients with chronic hepatitis B abstain from alcohol as it may accelerate liver damage. Patients should check with their doctors before taking any over-the-counter or prescription medications or herbal supplements. Some medications (such as acetaminophen) and herbal products (kava) can increase the risk of liver damage.
If the disease progresses to liver failure, liver transplantation may be an option. It is not foolproof, however. Viral recurrence is high in patients with hepatitis B. However, regular, lifelong injections of hepatitis B immune globulin (HepaGam B) can reduce the risk for re-infection following liver transplantation.
Antiviral drug therapy is used to treat both acute and chronic forms of hepatitis C. The vast majority of people infected with hepatitis C virus develop the chronic form. The standard treatment for chronic hepatitis C is combination therapy with the antiviral drugs pegylated interferon and ribavirin. Other types of drugs may also be used. Doctors will generally recommend drug treatment unless there are medical contraindications to it. (See "Candidates for Interferon Treatment in Medications" section.)
Patients with chronic hepatitis C should receive genotype testing to determine the treatment approach. There are six types of hepatitis C genotypes and patients have different responses to drugs depending on their genotype. For example, patients with genotypes 2 or 3 are three times more likely to respond to treatment than patients with genotype 1. The recommended course of duration of treatment also depends on genotype. Patients with genotype 2 or 3 usually have a 24-week course of treatment whereas a 48-week course is recommended for patients with genotype 1.
Patients are considered cured when there is no evidence of hepatitis C on lab testing for 2 years. For most patients who have a response, viral loads remain undetectable indefinitely. However, some patients can become re-infected after drug therapy.
Patients who develop cirrhosis or liver cancer from chronic hepatitis C may be candidates for liver transplantation. Unfortunately, hepatitis C usually recurs after transplantation, which can lead to cirrhosis of the new liver in at least 25% of patients 5 years after transplantation. The issue of retransplantation for patients with recurrent hepatitis C is a matter of debate.
Patients with chronic hepatitis C should abstain from alcohol as it can speed cirrhosis and end-stage liver disease. Patients should also check with their doctors before taking any non-prescription or prescription medications, or herbal supplements.
Popular herbal remedies for hepatitis include ginseng, glycyrrhizin (a compound in licorice), catechin (found in green tea), and silymarin (found in milk thistle). However, there is no evidence that these herbs are helpful for hepatitis or other liver diseases.
Milk thistle is the most studied of these herbs and evidence of its benefit have been mixed. Some studies have indicated that milk thistle may help improve liver enzyme levels. However, recent rigorous reviews have found that the herb does not reduce deaths from liver disease caused by hepatitis B or C.
Patients with hepatitis should be aware that some herbal remedies may cause liver damage. In particular, kava (an herb used to relieve anxiety and tension) may be dangerous for people with chronic liver disease. Other herbs associated with liver damage include chaparral, kombucha mushroom, mistletoe, pennyroyal, and some traditional Chinese herbs.
Liver transplantation may be indicated for patients with severe cirrhosis or for patients with liver cancer that has not spread beyond the liver.
Current 5-year survival rates after liver transplantation are 55 - 80%, depending on different factors. Patients report improved quality of life and mental functioning after liver transplantation
Patients should consider medical centers that have performed more than 50 transplants per year and produced better-than-average results. Unfortunately, there are far more people waiting for liver donors than there are available organs. [For more information, see In-Depth Report #75: Cirrhosis.]
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