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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 28, 2021; 9(6): 522-542
Published online Dec 28, 2021. doi: 10.13105/wjma.v9.i6.522
Newer developments in viral hepatitis: Looking beyond hepatotropic viruses
Manasvi Gupta, Gaurav Manek, Kaitlyn Dombrowski, Rakhi Maiwall
Manasvi Gupta, Kaitlyn Dombrowski, Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
Gaurav Manek, Department of Pulmonology and Critical Care, Cleveland Clinic, Cleveland, OH 44195, United States
Rakhi Maiwall, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Gupta M, Manek G and Dombrowski K were involved in the study conceptualization, data curation, funding acquisition, investigation, project administration, and writing of the original draft; Maiwall R performed the review and editing of the manuscript.
Conflict-of-interest statement: No conflict-of-interest for any of the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rakhi Maiwall, MD, Additional Professor, Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India. rakhi_2011@yahoo.co.in
Received: July 16, 2021
Peer-review started: July 16, 2021
First decision: August 9, 2021
Revised: September 9, 2021
Accepted: December 8, 2021
Article in press: December 8, 2021
Published online: December 28, 2021
Processing time: 164 Days and 10.6 Hours
Abstract

Viral hepatitis in the entirety of its clinical spectrum is vast and most discussion are often restricted to hepatotropic viral infections, including hepatitis virus (A to E). With the advent of more advanced diagnostic techniques, it has now become possible to diagnose patients with non-hepatotropic viral infection in patients with hepatitis. Majority of these viruses belong to the Herpes family, with characteristic feature of latency. With the increase in the rate of liver transplantation globally, especially for the indication of acute hepatitis, it becomes even more relevant to identify non hepatotropic viral infection as the primary hepatic insult. Immunosuppression post-transplant is an established cause of reactivation of a number of viral infections that could then indirectly cause hepatic injury. Antiviral agents may be utilized for treatment of most of these infections, although data supporting their role is derived primarily from case reports. There are no current guidelines to manage patients suspected to have viral hepatitis secondary to non-hepatotropic viral infection, a gap that needs to be addressed. In this review article, the authors analyze the common non hepatotropic viral infections contributing to viral hepatitis, with emphasis on recent advances on diagnosis, management and role of liver transplantation.

Keywords: Hepatitis, Non hepatotropic viruses, Cytomegalovirus, Herpes simplex virus, Coronavirus-2019, Liver transplant

Core Tip: With growing numbers of patients receiving solid organ transplantation including liver transplant, and subsequent immunosuppression there is an increasing incidence of non-hepatotropic viruses causing hepatitis. Several gaps exist in the diagnosis and management of such patients. Through this review article we attempt to outline the important non hepatotropic viruses causing liver injury. We also address the challenges in diagnosis, current and future prospects in treatment as well as prevention of these infections.