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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

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

  1. Differentiate the five types of viral hepatitides by their epidemiology, etiology, pathophysiology, clinical presentation, and natural history.

  2. Identify modes of transmission and risk factors among the major types of viral hepatitis.

  3. Evaluate hepatic serologies to understand how the type of hepatitis is diagnosed.

  4. Create treatment goals for a patient infected with viral hepatitis.

  5. Recommend appropriate pharmacotherapy for prevention of viral hepatitis.

  6. Develop a pharmaceutical care plan for treatment of chronic viral hepatitis.

  7. Formulate a monitoring plan to assess adverse effects of pharmacotherapy for viral hepatitis.

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KEY CONCEPTS

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  • Image not available. Prevention and treatment of viral hepatitis may prevent progression to chronic hepatitis, cirrhosis, end-stage liver disease, and hepatocellular carcinoma.

  • Image not available. Acute viral hepatitis is primarily managed with supportive care.

  • Image not available. Good personal hygiene and proper disposal of sanitary waste are required to prevent fecal–oral transmission of the hepatitis A and E virus.

  • Image not available. Individuals may minimize the risk of acquiring both hepatitis B and C infection by avoiding contaminated blood products and not partaking in high-risk behavior such as illicit IV drug use.

  • Image not available. Persons at high risk of acquiring viral hepatitis A, B, or C infection should be vaccinated with the hepatitis A and/or B vaccine to prevent complications of liver disease.

  • Image not available. A vaccine that combines both inactivated hepatitis A and recombinant hepatitis B (Twinrix) is approved for immunizing individuals older than 18 years with indications for both hepatitis A and B vaccines.

  • Image not available. The drug of choice for chronic hepatitis B depends on the patient's past medical history, alanine aminotransferase (ALT) level, hepatitis B virus (HBV) DNA level, hepatitis B envelope antigen (HBeAg) status, severity of liver disease, and history of previous HBV therapy.

  • Image not available. Treatment for chronic hepatitis C depends on the patient's past medical history, previous hepatitis C virus (HCV) treatment history, severity of liver disease, and HCV genotype.

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INTRODUCTION

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The most common types of viral hepatitis include hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV). Acute hepatitis may be associated with all five types of hepatitis and rarely exceeds 6 months in duration. Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. Image not available. Chronic viral hepatitis may lead to the develop-ment of cirrhosis and may result in end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). Complications of ESLD include ascites, edema, hepatic encephalopathy, infections (e.g., spontaneous bacterial peritonitis), hepatorenal syndrome, and esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD and HCC.

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Viral hepatitis may occur at any age and is the most common cause of liver disease in the world. The true prevalence and incidence may be underreported because most patients are asymptomatic. The epidemiology, etiology, and pathogenesis vary depending on the type of hepatitis and are considered separately below.

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EPIDEMIOLOGY AND ...

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