| Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc |
| Journal website https://www.gastrores.org |
Review
Volume 14, Number 3, June 2021, pages 139-156
A Focused Review on Recent Advances in the Diagnosis and Treatment of Viral Hepatitis
Tables
| At-risk group | Virus |
|---|---|
| HAV: hepatitis A virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HDV: hepatitis D virus; HEV: hepatitis E virus; HBsAg: HBV surface antigen. | |
| Individuals who have ever injected drugs | HAV, HBV, HCV, HEV |
| Individuals suffering from homelessness | HAV, HBV, HCV |
| Men who have sex with men | HAV, HBV, HCV |
| Patients with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis and home dialysis | HBV, HCV, HEV |
| Sexually active individuals (more than one partner in the past 6 months) | HBV, HCV |
| Individuals living in close household contact with or have sexual contacts with active infected patients | HBV, HCV |
| Health care providers and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluid | HBV, HCV |
| Inmates and staff of correctional facilities | HBV, HCV |
| All pregnant women | HBV, HEV |
| Exposure to undercooked meat, fish, or shellfish | HAV, HEV |
| Individuals born in or adopted from countries where hepatitis B is common (Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East) | HBV |
| Individual born or adopted in areas where hepatitis C is common (Central Asia, East Asia, North Africa, and West Africa) | HCV |
| Individuals with chronic HBV infection | HDV, HEV |
| Those with blood transfusion or organ donation prior to 1992 | HCV |
| Individuals who have ever injected drugs who are HBsAg+ | HDV |
| Men who have sex with men who are HBsAg+ | HDV |
| Individuals who are HBsAg+ and have elevated liver function tests | HDV |
| Individuals who are HBsAg+ and have immigrated from areas of high HDV endemicity | HDV |
| HBV cirrhosis | HBV non-cirrhotic HBeAg+ | HBV non-cirrhotic HBeAg- | Other indications to initiate treatment | |
|---|---|---|---|---|
| HBV: hepatitis B virus; HBeAg: hepatitis B E antigen; ALT: alanine aminotransferase; EASL: European Association for the Study of the Liver; AASLD: American Association for the Study of Liver Diseases. | ||||
| EASL | Treat | HBV DNA cutoff of 2,000 IU/mL | HBV DNA cutoff of 2,000 IU/mL | ALT > 40 U/L with histologic evidence of moderate necroinflammation and/or moderate fibrosis ALT > 40 U/L with histologic evidence of moderate necroinflammation and/or liver stiffness > 9 kPa ALT > 80 U/L and HBV DNA > 20,000 IU/mL, if histology is not available. |
| AASLD | Treat | HBV DNA cutoff of 20,000 IU/mL | HBV DNA cutoff of 2,000 IU/mL | ALT > 70 U/L (for male) and ALT > 50 U/L (for female) or histologic evidence of moderate or severe necroinflammation or significant fibrosis for initiating treatment |
| AASLD | Treat | HBV DNA cutoff of 20,000 IU/mL | HBV DNA cutoff of 2,000 IU/mL | ALT > 70 U/L (for male) and ALT > 50 U/L (for female) or histologic evidence of moderate or severe necroinflammation or significant fibrosis for initiating treatment |
| Patient population | First line treatment regimens |
|---|---|
| aPatients without baseline NS5A RAS Y93H for velpatasvir. bPatients both with and without cirrhosis. | |
| Genotype 1a without cirrhosis | Elbasvir/grazoprevir, glecaprevir/pibrentasvir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir |
| Genotype 1a + compensated cirrhosis | Elbasvir/grazoprevir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir, glecaprevir /pibrentasvir |
| Genotype 1b without cirrhosis | Elbasvir/grazoprevir, glecaprevir/pibrentasvir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir |
| Genotype 1b + compensated cirrhosis | Elbasvir/grazoprevir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir |
| Genotype 2 without cirrhosis | Glecaprevir/pibrentasvir, sofosbuvir/velpatasvir |
| Genotype 2 + compensated cirrhosis | Sofosbuvir/velpatasvir |
| Genotype 3 without cirrhosis | Glecaprevir/pibrentasvir, sofosbuvir/velpatasvir |
| Genotype 3 + compensated cirrhosis | Sofosbuvir/velpatasvira |
| Genotype 4 without cirrhosis | Elbasvir/grazoprevir, glecaprevir/pibrentasvir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir |
| Genotype 4 + compensated cirrhosis | Sofosbuvir/velpatasvir |
| Genotypes 5 + 6b | Glecaprevir/pibrentasvir |
| Virus | Diagnostic testing modalities | Treatment strategies |
|---|---|---|
| HAV: hepatitis A virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HDV: hepatitis D virus; HEV: hepatitis E virus; EIA: enzyme immunoassay; IgM: immunoglobulin M; HBsAg: HBV surface antigen; HBeAg: hepatitis B E antigen; HBcrAg: Hepatitis B core-related antigen; NAAT: nucleic acid amplification technology; POC: point of care. | ||
| HAV | IgM anti-HAV antibodies via EIA Rapid immunochromatographic test IgG anti-HAV rapid salivary test | Supportive care |
| HBV | HBsAg, HBeAg, and IgM/IgG anti-HBc antibodies via EIA Quantitative HBV DNA level via NAAT Quantitative HBsAg HBcrAg POC HBsAg | Interferon formulations Nucles(t)ide analogs |
| HCV | IgG anti-HCV antibodies via EIA Quantitative HCV RNA level via NAAT POC anti-HCV | DAAT Interferon formulations |
| HDV | Total anti-HDV antibody Quantitative HDV RNA level via NAAT | No FDA approved formulations Bulevirtide (myrcludex): viral entry inhibitor approved in Europe |
| HEV | Anti-HEV IgG/IgM antibodies via EIA Quantitative HEV RNA via NAAT POC anti-HEV1 and anti-HEV3 IgM | Ribavirin ± pegylated interferon HEV vaccine in China |