What Type of Hepatitis Is Most Deadly?

My uncle was just diagnosed with hepatitis B. He has had a hard life and has battled addictions, so hopefully his hepatitis diagnosis will be a wakeup call. But I worry whether the illness might be terminal. Can you die from hepatitis B? What type of hepatitis is the most deadly?

There are 3 main types of hepatitis: hepatitis A, B, and C. Hepatitis C can be more severe and is the most deadly, but even those with acute illness can recover without lasting liver damage.

Up to 70% of those chronically infected with hepatitis C develop chronic liver disease, and up to 20% develop cirrhosis.

According to the Centers for Disease Control, up to 5% of patients with hepatitis C will die from cirrhosis or liver cancer. There were 19,600 deaths due to hepatitis C in 2014, compared to about 1,800 deaths from hepatitis B. Hepatitis A is rarely fatal.

With the newest forms of antiviral treatment, the most common types of chronic hepatitis C can be cured in most individuals. The treatment of chronic hepatitis C has gone through several generations of medications. Not long ago, treatment was limited to interferon alpha-2b (Intron A) or pegylated interferon alpha-2b (Pegetron), and ribavirin (RibaPak and others). Interferon and pegylated interferon need to be injected under the skin (subcutaneously), while ribavirin is taken by mouth. This combination therapy is infrequently used today, being recommended for only the least common genotypes of hepatitis C virus (HCV).

Since 2010, direct-acting antiviral (DAA) drugs have been in use. The second generation of antivirals for HCV was the protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis), both taken by mouth. These were used in combination with the earlier drugs to increase effectiveness (efficacy). These drugs are also no longer in common use, and have been replaced by better options.

As more has been learned about how hepatitis C virus multiplies (reproduces) within the liver cells, new drugs continue to be developed to interfere with this multiplication at different stages. As such, we no longer think in terms of generations of drugs, but rather categories of action. Research and development of these direct-acting antivirals continue, with new agents coming to market every few months. Each category is improved and expanded by the addition of new drugs, which are safer and more effective.

As previously mentioned, there are multiple genotypes of HCV. Different antiviral drugs are approved and recommended for different genotypes, based upon the demonstrated effectiveness in clinical trials. This is especially true because the recommended therapy for any given genotype changes frequently as new drugs and new research become available. A detailed description of all the recommendations, options, and how they work is beyond the scope of this article. All of these drugs should be used only under the management of a medical specialist.

Currently available and commonly used direct-acting antiviral drugs include:

• simeprevir (Olysio)
• paritaprevir/ritonavir (always combined)
• ledipasvir
• ombitasvir
• daclatasvir (Daklinza)
• sofosbuvir (Sovaldi)
• dasabuvir

Some of these (those without a brand name in parenthesis) are only used in fixed combination drugs:

• ombitasvir, paritaprevir/ritonavir (Technivie)
• ombitasvir, paritaprevir/ritonavir and dasabuvir (Viekira Pak)
• ledipasvir sofosbuvir (Harvoni)
• elbasvir grazoprevir (Zepatier)
• glecaprevir pibrentasavir (Mavyret)
• sofobuvir velpatasavir (Epclusa)