There is no antiviral therapy or other medication available to treat hepatitis A. Some patients experience no symptoms at all while others feel better when resting. If there are no complaints, physical activity is possible.
A balanced, low-fat and high carbohydrate diet and plenty of fluids are good for the liver. Alcohol and liver-damaging medication should be avoided. The illness usually subsides by itself after a few weeks. Hepatitis A patients are not contagious, if the rules for hand hygiene when caring for or touching a patient are followed. Relatives are protected against hepatitis A if they are vaccinated.
90 per cent of all hepatitis B cases heal spontaneously. There is no medication for treating acute hepatitis B infections. Chronic hepatitis B can be treated with antiviral medicines containing pegylated interferon-alpha or with other antiviral medicines. Because genetic make-up of the virus remains in the liver even after successfully treating the infection, chronic hepatitis B can almost never be healed completely. But the treatment reduces the viral load in the blood and serious complications of liver cirrhosis such as bleeding and liver cancer can be prevented. During a successful treatment, liver function usually improves again and fibrosis of the liver is reduced. Patients with advanced liver disease (cirrhosis and/or liver cancer) or a serious hepatitis B infection may need a liver transplant.
A chronic hepatitis C infection can, in principle, be cured today. Until recently, the standard treatment was a combination of interferon and ribavirin. These therapies are physically and mentally taxing. Today, there are many new antiviral agents available that are more precise and successful. They can be used alone or in combination with interferon and/or ribavirin or in combination with each other. They are highly effective and have only very few side effects.
The new therapies are considerably less hard on the patient. Which in turn enhances the chances of adhering to them and getting cured. This applies also to difficult to treat patients with liver cirrhosis, HIV/HCV co-infected patients and those who have had liver transplants.
In recent years, so-called Direct Acting Antiviral agents (DAAs) have been developed. They directly interfere with the lifecycle of the hepatitis C virus. These medicines inhibit various viral proteins (protease, polymerase or the NS5A protein) and prevent viruses from multiplying in hepatic cells and attacking other cells. At the end of 2011, two protease inhibitors for genotype 1 hepatitis were released as the first representatives of DAAs in Switzerland. Genotype 1 is the most common type of hepatitis C in Switzerland, affecting almost half the people infected, and it had been difficult to treat so far. The first protease inhibitors, who still need to be combined with interferon and ribavirin, have brought an improvement of healing rates. The side effects, however, were still severe. This improved with the second generation of DAAs. The first agent, a polymerase inhibitor, was released in the summer of 2014. Others followed. The new medicines only have to be taken once or twice a day, produce considerably less side effects and need to be taken over a substantially shorter period of time. They can be combined with each other, showing that interferon-free treatments are the future.
In clinical studies, more than 90 per cent of hepatitis C patients have been able to be cured thanks to the new medication, and with considerable fewer side effects. Because of the large number of affected people and the high treatment cost, the Federal Office of Public Health (FOPH) first decided to restrict prescriptions. Since 1 Octobre 2017, all treatments are paid for by health insurances.
All in all, the new medicines open up a perspective that, up until now, has not been thought possible: the possibility of eliminating hepatitis C in the foreseeable future, and thus saving millions of lives.