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  • Image not available. Hepatitis A is transmitted via the fecal–oral route. Transmission is most likely to occur through travel to countries with high rates of hepatitis A, poor sanitation and hygiene, and overcrowded areas.
  • Image not available. Hepatitis A causes an acute, self-limiting illness and does not lead to chronic infection. There are three stages of infection: incubation, acute hepatitis, and convalescence. Rarely, the infection progresses to liver failure.
  • Image not available. Treatment of hepatitis A consists of supportive care. There is no role for antiviral agents in treatment.
  • Image not available. Hepatitis B causes both acute and chronic infection. Infants and children are at high risk for chronic infection.
  • Image not available. Several therapies are available for hepatitis B, including lamivudine, interferon α2b, pegylated interferon α2a, entecavir, adefovir, telbivudine, and tenofovir. Patient status, extent of disease, viral load, and viral resistance are all considered when deciding on treatment.
  • Image not available. Chronic hepatitis B patients may require long-term therapy. Long-term therapy poses a challenge because of the potential for developing resistance. Resistance to lamivudine and telbivudine is most common, although resistance mutations to adefovir and entecavir have also been seen. Optimal treatment of resistant strains is unknown.
  • Image not available. Prevention of hepatitis B infections focuses on immunization of all children and at-risk adults.
  • Image not available. Hepatitis C is an insidious, blood-borne infection. Injection drug use is the major mode of transmission in the United States.
  • Image not available. Combination pegylated interferon and ribavirin therapy is the treatment of choice for hepatitis C. Treatment duration for hepatitis C infections is 48 weeks for viral genotype 1, and 24 weeks for genotypes 2 and 3. However, therapy may be optimized based on infecting genotype and virologic response. Viral genotype 1 is most difficult to treat.
  • Image not available. Side effects of hepatitis C therapy pose a significant obstacle to completion of therapy and chance for cure. Adjunct pharmacologic therapy and dose reductions may be necessary to prevent premature cessation of treatment.

Upon completion of the chapter, the reader will be able to:

  • 1. Compare the different modes of transmission for hepatitis A, B, and C.
  • 2. Discuss the role of infected children in hepatitis A transmission.
  • 3. Compare methods of preventing hepatitis A infection.
  • 4. Interpret serologic markers in hepatitis B infection.
  • 5. Discuss the clinical sequelae of chronic hepatitis B infection.
  • 6. Recommend appropriate treatment for chronic hepatitis B infection.
  • 7. Discuss problems of resistance in chronic hepatitis B treatments.
  • 8. Assess the significance of infection with hepatitis B e-antigen (HBeAg)-negative mutants.
  • 9. Recommend nonpharmacologic care in hepatitis B and C infection.
  • 10. Assess candidates for hepatitis C screening.
  • 11. Discuss the clinical sequelae and natural history of chronic hepatitis C infection.
  • 12. Differentiate the clinical impact of infection by particular genotype in hepatitis C.
  • 13. Discuss the significance of attaining rapid virologic response (RVR) and early virologic response (EVR) in hepatitis C treatment.
  • 14. Cite the standard of care for hepatitis C infection.
  • 15. Describe the side effects of hepatitis C therapy.

The major hepatotrophic viruses responsible for viral hepatitis are hepatitis A, ...

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