Treatment of Hepatitis

Content

1. Exploring types of the hepatitis
2. Drug treatment with regard to the hepatitis virus type
3. Symptomatic treatment is indicated to each patient
4. Liver transplantation
5. Leading hospitals and cost of treatment
6. Booking Health offers making diagnosis and receiving treatment abroad

The medical term "hepatitis" refers to the inflammation of the liver. The causes of the disease include viral infections, autoimmune processes, as well as negative influence of alcohol, medicines, illicit drugs, toxins, etc. Most often people with hepatitis are infected with the hepatitis virus. Thus, treatment of hepatitis depends greatly on the etiology of the condition. Departments of Gastroenterology and Hepatology in specialized healthcare facilities offer preventive vaccines, antiviral medical agents, detoxification and symptoms alleviation. In the most severe cases, liver transplant is the only suitable therapeutic option.

Exploring types of the hepatitis

Efficient therapy of hepatitis is impossible without determining the hepatitis virus type. There are 5 hepatitis viruses. Each of them has its own clinical course and treatment approaches.

The hepatitis virus A (HVA) is the acute intestinal infection. It is highly contagious and is transmitted by consuming contaminated food or water. "Contaminated" means that it contains feces of a person with hepatitis virus A who has symptoms or may feel healthy. Thus, if one of the family members is diagnosed with hepatitis virus A, other family members must practice good hygiene. Fortunately, recovery without therapy is possible.

The hepatitis virus B (HVB) is the widespread chronic infectious pathology. According to the Centers for Disease Control and Prevention (USA), about 350 million people worldwide have this medical condition. Transmission of hepatitis B requires direct contact with the infected body fluids, such as semen or vaginal secretions, blood. People with hepatitis B have to take antiviral drugs lifelong, regardless of their health state, as the virus persists in the organism causing unpleasant symptoms.

The hepatitis virus C (HVC) has the same ways of transmission as the hepatitis B. Hepatitis C is one of the most widespread bloodborne infections. Despite slow progression and mild disease course, this virus often leads to the hepatic insufficiency and liver failure. Considering high prevalence of virus and high incidence of disease, novel treatments for hepatitis C are under constant development.

The hepatitis virus D (HVD) is the rare pathology that may complicate the hepatitis B clinical course. It is impossible to be diagnosed with HVD only, as this virus is not able to survive without HVB. The infection is bloodborne, as well.

The hepatitis virus E (HVE) is the waterborne infection. HVE is mainly found in regions with poor sanitary conditions, where water supply may be contaminated with fecal masses. Only about 15% of infected people experience symptoms. HVE does not have any specific treatment and can be prevented with the help of vaccine (it is currently available in China).

The hepatitis can also be noninfectious. These are autoimmune and alcoholic hepatitis.

Drug treatment with regard to the hepatitis virus type

The hepatitis virus B has four possible clinical forms:

1. Asymptomatic – may do not cause symptoms at all or cause mild symptoms
2. Icteric – cause jaundice, fever, nausea, fatigue
3. Fulminant – are a life-threatening condition due to the development of acute liver failure
4. Chronic – may lead to the hepatocellular carcinoma or liver cirrhosis development

First two forms require no more than symptomatic therapy. Fulminant forms require admitting to hospital, often – to the intensive care unit. Chronic hepatitis requires lifelong therapy aimed at suppressing the virus multiplication and improving health condition.

Antiviral medications are the basis of the therapeutic regimen. A doctor may administer one of the following drugs: tenofovir, entecavir, lamivudine, telbivudine, and adefovir. Antiviral medications are usually taken by mouth. Another treatment option is injections of interferon. Peginterferon alfa 2-a is suitable for patients with mild symptoms and preserved liver function. It makes the patient's immune system more powerful, so that it has another chance to take control over the virus.

The hepatitis virus C has the same clinical forms. When talking about chronic form, a doctor selects drugs based on the hepatitis C genotype (there are genotypes 1, 2, 3, 4, 5, 6) and presence or absence of liver cirrhosis. Precise diagnosis making is essential in hepatitis C, as different genotypes of the virus are sensitive to different medicines. In most cases, sofosbuvir, velpatasvir, and daclatasvir are used (antiviral medications). Pregnancy and breastfeeding are contraindications to their usage.

Treatment of the hepatitis virus D is added to the treatment for hepatitis B. It includes administration of peginterferon alfa 2-a for at least 48 weeks.

Symptomatic treatment is indicated to each patient

Hepatitis virus A affects function of the liver by causing inflammation and damaging it. Patients with mild forms of the disease do not require any therapy at all. Typically, they restore their health completely during several weeks and have no permanent liver damage according to the results of follow-up tests. If the course of the disease is more severe, therapy for symptoms management is required. However, fulminant forms of HVA are diagnosed in 0.2-0.4% of patients. People who are at risk of acquiring hepatitis A may have the protective vaccine.

Hepatitis virus E does not have a preventive vaccine and can lead to death in 20% of pregnant women. However, in most people it either causes no symptoms or requires symptomatic therapy only.

Treatment for symptoms management includes administration of the following medications:

1. OTC antipyretics, such as acetaminophen, ibuprofen, etc.
2. Medications against vomiting (antiemetics)
3. Antidiarrheals, such as metoclopramide
4. Saline solutions and detoxification therapy
5. Individual medications, such as hypotensive, hypoglycemic, etc.

Liver transplantation

Liver transplantation is not a treatment for the virus of hepatitis. It is indicated to patients with chronic forms of the disease that has led to the development of liver cirrhosis and liver failure. Chronic forms are typical for:

• The hepatitis virus B – up to 10% of cases (and up to 90% of cases in children under 1 year of age)
• The hepatitis virus C – up to 50% of cases, with the risk of developing cirrhosis of 10-25%
• The hepatitis virus D – over 90% of cases, with rapid cirrhosis development

To undergo liver transplantation, patients who do not have donors are put on a waiting list. The waiting list considers a health condition (severity of state), body size and blood type. In addition, each patient receives an individual priority score according to the levels of creatinine, bilirubin and INR. A patient may receive liver from a living or a deceased donor.

The surgery may last up to 12 hours, as a liver is connected to large blood vessels (they include hepatic artery, hepatic veins, portal vein, and inferior vena cava). Total duration of hospital stay is individual, but it is better to have a vacation for 3 weeks or more. After the liver transplant, a patient needs to take immunosuppressants lifelong, so that the donor liver is not rejected and performs its function well.

Leading hospitals and cost of treatment

People with hepatitis may need different medical services, such as getting hepatitis A or B vaccine, checking the hepatitis C genetics, receiving systemic therapies or finding a donor for liver transplant. The following hospitals in different countries offer comprehensive management of hepatitis:

1. University Hospital Duesseldorf, Department of Gastroenterology, Hepatology and Infectology, Germany
2. University Hospital of Ludwig Maximilian University of Munich, Department of Gastroenterology and Hepatology, Germany
3. Memorial Sisli Hospital Istanbul, Department of Gastroenterology and Hepatology, Turkey
4. University Hospital Ulm, Department of Gastroenterology and Hepatology, Germany
5. Rambam Health Care Campus Haifa, Department of Gastroenterology, Israel

Treatment of hepatitis may become the financial challenge. Patients without health insurance usually want to know the cost of treatment course. Prices for the diagnostic procedures and elaboration of the initial treatment plan are as follows:

1. Diagnostics and conservative treatment of hepatitis virus A – from 1,141 EUR
2. Diagnostics and conservative treatment of hepatitis virus B – from 1,193 EUR
3. Diagnostics and conservative treatment of hepatitis virus C – from 1,283 EUR
4. Diagnostics and conservative treatment of hepatitis virus D – from 1,140 EUR
5. Diagnostics and conservative treatment of hepatitis virus E – from 1,296 EUR

This cost of treatment is approximate, as prices depend on the healthcare facility, type of treatment, presence of the concomitant health conditions, and other factors. It should also be noted that therapy for chronic hepatitis B and C is lifelong in most cases. Patients should discuss this with their healthcare providers and insurance companies.

Booking Health offers making diagnosis and receiving treatment abroad

People who are diagnosed with hepatitis are often not satisfied with local treatment protocols. Unfortunately, countries with poorly developed healthcare systems cannot offer target therapy aimed at preserving healthy hepatocytes and maintaining liver function. Those patients who want to receive more than simple symptoms management often choose travelling abroad as medical tourists.

Booking Health offers services that make visiting foreign hospitals easier. Having over 10 years of experience in the field of medical tourism, the company considers peculiarities of countries' legislation, wishes of patients and success rates of clinics all over the world.

Services of Booking Health include:

• Comparing and selecting the healthcare institution for getting the preventive vaccine, making diagnosis, receiving therapy or undergoing rehabilitation
• Establishing communication with the hospital and doctor
• Examining the existing medical records, preparing and explaining the basic medical program
• Controlling prices for the health services, so that clinics do not apply additional coefficients for foreigners (saving up to 50%)
• Making the appointment without long waiting
• Giving professional advice during all stages of medical program
• Help in buying medicines for basic therapy and symptoms management
• Communication with the clinic after the discharge, receiving and translating medical records
• Organization of additional health services, if necessary
• Booking accommodation, choosing plane tickets, transfer
• Services of medical coordinator (24/7) and interpreter

The quality of Booking Health work is confirmed by the international quality control certificate ISO 9001:2015. The company works under German legislation. To start planning treatment of hepatitis, leave your request on the website of Booking Health.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko