Treatment depends on which virus is responsible and whether the infection is acute or chronic. The acute illnesses are managed supportively, because most resolve on their own; the chronic infections are the ones that need drugs, and for hepatitis C they can be cured.
Acute hepatitis
There is no specific antiviral treatment for acute hepatitis A, acute hepatitis E or acute hepatitis B. Care is supportive: rest, a balanced diet and adequate fluids to replace losses from vomiting and diarrhoea. Medicines that can harm the liver are avoided, acetaminophen (paracetamol) in particular. Admission is decided case by case and is needed for severe disease or fulminant hepatitis, which may require liver transplantation.
Chronic hepatitis B
Chronic hepatitis B cannot be cured but can be suppressed. The first-line drugs are two oral nucleos(t)ide analogues with a high barrier to resistance, tenofovir and entecavir; they suppress viral replication rather than eliminate the virus, so treatment is usually lifelong. The WHO 2024 guidelines recommend treating adults and adolescents aged 12 years and older when any of the following is present: significant fibrosis or cirrhosis; HBV DNA above 2000 IU/mL with an elevated ALT; or specific risk factors such as coinfection, a family history of liver cancer, or immunosuppression. Suppressive treatment slows the advance of cirrhosis, reduces the incidence of liver cancer and improves long-term survival.
Chronic hepatitis C
Hepatitis C is curable. Pan-genotypic direct-acting antivirals (DAAs) — oral drugs that block the viral protease, polymerase and NS5A protein — cure more than 95% of infections, usually in a course of 8-12 weeks. Treatment is recommended for nearly everyone diagnosed, and the duration is adjusted mainly according to the presence of cirrhosis. Unlike hepatitis B, the goal is eradication of the virus, and a sustained virological response means cure.
Chronic hepatitis D
HDV has fewer options. Pegylated interferon alfa was long the only treatment, with poor response rates and frequent relapse. Bulevirtide, an entry inhibitor given by daily subcutaneous injection, was approved in Europe in 2023 for adults with compensated liver disease. Nucleoside analogues used for hepatitis B do not act on HDV itself, although they are still used to control the accompanying HBV infection.