Viral hepatitis is any inflammation of the liver caused by a specific virus.
There are a number of viruses which can cause viral hepatitis from hepatitis A to hepatitis E.
Some of these are transmitted in different ways. Some have vaccines such as hepatitis
A and hepatitis B. But the concerns we have around the viral hepatitis which cause chronic viral
liver disease namely hepatitis B and C and in some cases hepatitis D which can complicate
hepatitis B. Viral hepatitis is essentially diagnosed by
abnormalities in the liver enzymes where we see abnormalities in the transaminases and
these are confirmed by viral serology which we’ll be able to identify the virus which
is causing the viral hepatitis. There are a number of investigations we would
also undertake to investigate this further outside of laboratory tests such as ultrasound scans,
FibroScans, and in some cases, liver biopsy.
The treatment for viral hepatitis will depend on the virus causing the hepatitis in the
first instance. For example, hepatitis A and hepatitis E tend to be acute and self-limiting
infections meaning they get better themselves. The difficulty with viral hepatitis are the
viruses which cause more chronic disease and lead to chronic liver disease. These are specifically
hepatitis B, hepatitis C, and in some cases, hepatitis D or delta virus which is a super
co-infection with hepatitis B. For hepatitis C, we have new very effective
antiviral drugs which can eradicate the virus up to 95% of patients in relatively short
periods of time sometimes treatment for only 8 or 12 weeks.
Hepatitis B is more challenging in
that we’re not able to really deliver a cure when we treat it and what we’re actually
trying to do in this case is virally suppress the patients or reduce the virus to very low
levels where we don’t think it causes harm. This means that in hepatitis B, quite often
patients will be on medications for a very long period or even lifelong in some cases.
However, there are significant changes afoot with new drugs in development which should
improve our ability or chances of achieving a cure in hepatitis B.
Also, we’re still using pegylated interferon in a proportion of patients and this works
by boosting the host’s immune response against the virus essentially helping the patient
to control the virus themselves. But we’ll see a lot of developments over the coming
years in the treatment of hepatitis B as this is really an area of very rapid development.
One of the latest developments in the diagnosis and management of viral hepatitis is the use
of FibroScan. FibroScan is essentially a non-invasive modality for us to assess the degree of liver
damage or liver disease in patients presenting with viral hepatitis.
Previously, where we would often need to perform a liver biopsy to assess the amount of disease,
these days, we’re able to use the simple non-invasive technique which takes about 10
minutes to assess the amount of damage there is in the liver. This means that patients
at the same consultation are informed of whether they have significant disease or whether we’re
able to exclude significant disease. This is a major development in the field.
The ongoing treatment and management of viral hepatitis is relatively straightforward where
patients require treatment, and treatment is successful in the case of hepatitis C,
it’s common to be able to discharge these patients from the clinic provided there’s
no significant established liver disease. In this instance, we would use FibroScan
or in some cases liver biopsy to confirm that there’s no significant fibrosis or liver scarring.
If this is the case, the virus has been eradicated, patients can be discharged with specialist care.
However, in hepatitis B, because we use drugs
to virally suppress the patients to gain control of the virus without eradicating it, the treatment
is more long term and the supervision and monitoring are also long term. In this case,
we’d often use FibroScan to assess the patient’s longitudinally or over intervals of their
follow-up and where patients are on treatment, the Fibroscan can often be used to see if
there’s reversal of that liver scarring or liver fibrosis. Clearly, that is one of
the major goals of current treatment strategies.