- 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.
- 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.
- Treatment of hepatitis A consists of supportive care. There is no role for antiviral agents in treatment.
- Hepatitis B causes both acute and chronic infection. Infants and children are at high risk for chronic infection.
- 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.
- 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.
- Prevention of hepatitis B infections focuses on immunization of all children and at-risk adults.
- Hepatitis C is an insidious, blood-borne infection. Many people are unaware of their infection and risk significant morbidity and mortality.
- 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.
- 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:
Identify the modes of transmission for hepatitis A, B, and C.
Discuss the clinical significance of hepatitis A infections.
Compare the strategies used for the prevention of hepatitis A infection.
Interpret serologic markers in hepatitis B infection to determine whether a patient is infected, has achieved immunity, or is at risk for hepatitis B.
Discuss the clinical sequelae of chronic hepatitis B infection and the goals of therapy.
Compare and contrast the treatments for chronic hepatitis B infection.
Discuss the concerns of antiviral resistance in chronic hepatitis B treatments and possible strategies to minimize the risks of developing resistance.
Recognize the challenges in treating hepatitis B in special populations.
Recommend nonpharmacologic care in hepatitis B and C infection.
Identify patients in need of hepatitis C screening.
Discuss the clinical sequelae and natural history of chronic hepatitis C infection and goals of therapy.
Discuss the significance of evaluating virologic response during hepatitis C therapy and the impact on outcomes.
Cite the standard of care for hepatitis C infection.
Describe the challenges of hepatitis C therapy, including side effects, laboratory abnormalities, and challenges to adherence.
The major hepatotrophic viruses responsible for viral hepatitis ...