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  • image 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 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 Treatment of hepatitis A consists of supportive care. There is no role for antiviral agents in treatment.
  • image Hepatitis B causes both acute and chronic infection. Infants and children are at high risk for chronic infection.
  • image Several therapies are available for hepatitis B, including lamivudine, interferon-alfa, pegylated interferon-alfa, entecavir, adefovir, telbivudine, and tenofovir. Patient status, extent of disease, viral load, and viral resistance are all considered when deciding on treatment.
  • image 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, limiting the use of these treatments. Optimal treatment of resistant strains is unknown.
  • image Prevention of hepatitis B infections focuses on immunization of all children and at-risk adults.
  • image Hepatitis C is an insidious, blood-borne infection. Many people are unaware of their infection and risk significant morbidity and mortality.
  • image Combination pegylated interferon and ribavirin therapy with either boceprevir or telaprevir is the treatment of choice for hepatitis C genotype 1 infections. Treatment duration varies depending on response, previous treatment history, and the presence of cirrhosis. For genotypes 2, 3, and 4 the treatment of choice includes pegylated interferon and ribavirin.
  • image Boceprevir and telaprevir offer significant improvements in outcome for the treatment of hepatitis C genotype 1 infections but pose additional challenges and new concerns for multiple drug interactions.

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

  1. Identify the modes of transmission for hepatitis A, B, and C.

  2. Discuss the clinical significance of hepatitis A infections.

  3. Compare the strategies used for the prevention of hepatitis A infection.

  4. Interpret serologic markers in hepatitis B infection to determine whether a patient is infected, has achieved immunity, or is at risk for hepatitis B.

  5. Discuss the clinical sequelae of chronic hepatitis B infection and the goals of therapy.

  6. Compare and contrast the treatments for chronic hepatitis B infection.

  7. Discuss the concerns of antiviral resistance in chronic hepatitis B treatments and possible strategies to minimize the risks of developing resistance.

  8. Recognize the challenges in treating hepatitis B in special populations.

  9. Recommend nonpharmacologic care in hepatitis B and C infection.

  10. Identify patients in need of hepatitis C screening.

  11. Discuss the clinical sequelae and natural history of chronic hepatitis C infection and goals of therapy.

  12. Discuss the significance of evaluating virologic response during hepatitis C therapy and the impact on outcomes.

  13. Cite the standard of care for hepatitis C infection.

  14. Describe the challenges of hepatitis C therapy, including side effects, laboratory abnormalities, and challenges to adherence.

The major hepatotrophic viruses responsible for viral hepatitis ...

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