Minireviews
Copyright ©The Author(s) 2021.
World J Meta-Anal. Apr 28, 2021; 9(2): 139-152
Published online Apr 28, 2021. doi: 10.13105/wjma.v9.i2.139
Table 1 Comparison of hepatotropic viruses hepatitis A-E
Hepatitis
A
B
C
D
E
Viral structureNaked, ssRNA (Picornavirus)Envelope, dsDNA (Hepadnavirus)Envelope, ssRNA (Flavivirus)Envelope, ssRNA (-ve) (Deltavirus)Naked, ssRNA (Hepevirus)
TransmissionFaecal-oralParenteral, sexualParenteral, sexualParenteral, sexualFaecal-oral
Incidence1.4 million> 250 million[88] > 80 millionAbout 12 million (prevalence)[89] 20 million
Chronic infectionNoAbout 90% of infants infected; about 2%-6% adult infected70% (55%-85%)< 5% of those infected with HBV, > 80% of superinfection)[90] No (very rarely in immunosuppressed adults)[91]
Other disease associationsNoneHCC, cirrhosisHCC, cirrhosisCirrhosis, fulminant hepatitisNone (cirrhosis in chronic HEV infection)
TreatmentSupportiveViral suppressive therapy (see criteria for commencement of treatment below)Eradication therapy DAA (gold standard)PEG-IFN (sparse data)Supportive
Table 2 Diagnosing hepatitis A-E
Hepatitis
Serological testing
Molecular testing (via PCR), quantitative            
AAnti-HAV IgM (acute); Anti-HAV IgG (previous infection, vaccination); Note incubation period of 28 d[92] HAV RNA
BAnti-HBc (contact with HBV infection); HBsAg (current infection) appears 1-3 wk post exposure, duration > 24 wk denotes chronicity; Anti-HBS (vaccination, cleared HBV infection); HBeAg (high replication phase (> 10000 IU/mL); Anti-HBe (low replication phase (< 10000 IU/mL); Note incubation 90 d (ranges 45-160 d); Window period 1: first about 8 d of infection; Window period 2: clearance of HBsAg during this period Anti-HBc IgM is detectable[93] HBV DNA
CAnti-HCV: Note incubation 6-7 wk (ranges 2 wk to 6 mo)[93] HCV RNA
DAnti- HDV IgGHDV RNA
EAnti-HEV IgM and IgG and IgAHEV RNA
Table 3 European Association for the Study of the Liver 2017 clinical practice guidelines on the management of hepatitis B virus infection[12]
Clinical practice guidelines
All patients with HBeAg-positive or -negative chronic hepatitis B, defined by HBV DNA (2000 IU/mL, ALT) upper limit of normal (ULN) and/or at least moderate liver necroinflammation or fibrosis, should be treated (Evidence level I, grade of recommendation 1)
Patients with compensated or decompensated cirrhosis need treatment, with any detectable HBV DNA level and regardless of ALT levels (Evidence level I, grade of recommendation 1)
Patients with HBV DNA (20000 IU/mL, and ALT) 2 × ULN should start treatment regardless of fibrosis degree (Evidence level II-2, grade of recommendation 1)
Patients with HBeAg-positive chronic HBV infection, defined by persistently normal ALT and high HBV DNA levels, may be treated if they are older than 30 years regardless of the severity of liver histological lesions (Evidence level III, grade of recommendation 2)
Patients with HBeAg-positive or HBeAg-negative chronic HBV infection and family history of HCC or cirrhosis and extra-hepatic manifestations can be treated even if typical treatment indications are not fulfilled (Evidence level III, grade of recommendation 2)
Table 4 Comparing pegylated-interferon therapy to nucelos(t)ide analogues therapy

PEG-IFN
NA
Route of administrationSubcutaneousOral
Length of treatment48 wkLong-term in chronic HBV (stopping may be considered in some cases[13]); 8-16 wk in HCV
ContraindicationsMany (i.e., decompensated disease, comorbidities)None (dose adjustment according to eGFR)
ToleranceInferior tolerabilityExcellent tolerance
Side effectsSignificant adverse events (psychiatric, neurologic, endocrinological)Renal impairment (some DAA)[12]
SVR in HCV40%-75%[94,95] > 90%[46]
Efficacy in chronic HBV> 30% HBeAg loss; 3%-5% HBsAg loss[96] > 11%-18% eAg loss (lower rate of HBeAg seroconversion); Very low HBsAg loss[97]
CostExpensiveExpensive when given long-term (i.e., chronic HBV infection)[98]
ResistanceNoYes
Table 5 First-line recommended direct-acting antiviral therapies for hepatitis C patients
Genotype
1
2
3
4
5/6
DAA schedule (non-cirrhotic)Sofosbuvir/Ledipasvir; Or Glecaprevir/PibrentasvirSofosbuvir/VelpatasvirSofosbuvir/VelpatasvirSofosbuvir/LedipasvirSofosbuvir/Ledipasvir
Duration8-12 wk12 wk12 wk12 wk12 wk
DAA schedule (cirrhotic)Sofosbuvir/LedipasvirSofosbuvir/VelpatasvirGlecaprevir/PibrentasvirSofosbuvir/LedipasvirSofosbuvir/Ledipasvir
Duration12 wk12 wk8-16 wk12 wk12 wk