Management of hepatitis B and C in special population

Abstract

Chronic viral hepatitis is one of the leading causes of cirrhosis worldwide. Chronic hepatitis B is more common in the Asia-Pacific region due to the larger population and lower screening availability. Hepatitis C predominates in the west due to injection drug abuse. The discovery of (oral) direct-acting antiviral agents (DAAs) has changed the landscape of chronic hepatitis C (CHC) management. Nucleos(t)ide analogs (NUCs) have also changed the approach to the treatment of chronic hepatitis B (CHB). Oral NUCs and DAAs have excellent efficacy and patient acceptance as well as a lower risk of resistance. However, certain populations have no robust data and safety and efficacy of such oral drugs is still evolving. In this review, we provide an overview of the management of CHB and CHC in special populations, such as those with chronic kidney disease, pregnant women, healthcare workers, and those undergoing chemo- or immunosuppressive therapy.

Keywords: Chronic kidney disease; Pregnancy; Hepatitis B; Hepatitis C; Health care professionals; Tenofovir

Core Tip: Hepatitis B and hepatitis C are leading causes of liver disease and pose significant burdens on healthcare and the economy, especially in developing countries. The management of chronic hepatitis B and C in special populations is less known. In this review, we discuss the indications, timing of treatment, and safety of drugs in special populations infected with hepatitis B or C. The special populations discussed herein are those with chronic kidney disease, pregnant women, coinfected patients, healthcare workers, and patients undergoing chemotherapy.