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

  1. Differentiate the five types of viral hepatitis by 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 care plan for treatment of chronic viral hepatitis.

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


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. KEY CONCEPT Chronic viral hepatitis may lead to the development of cirrhosis and may result in end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC). Complications of ESLD include ascites, edema, hepatic encephalopathy, infections (eg, spontaneous bacterial peritonitis), hepatorenal syndrome, and esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD and HCC.

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.


Hepatitis A

Hepatitis A (HAV) affects 1.4 million people yearly worldwide.1 The prevalence is highest in economically challenged and underdeveloped countries, including Africa, parts of South America, the Middle East, and Southeast Asia.2 The decrease in HAV incidence is due to vaccination programs, but outbreaks may still occur, as evidenced in 2013 by a food outbreak with pomegranate seeds affecting 162 people over 10 States in the United States.3 The number of acute HAV infections and hospitalizations annually have decreased markedly since the introduction of the HAV vaccine in 1995.4

HAV is primarily detected in contaminated feces and infects people via the fecal–oral route.1,2 Outbreaks occur in areas of poor sanitation.2 About 45% of the reported cases have no identifiable risk factors; individuals at greatest risk of acquiring HAV are listed in Table 24–1.2

Table 24–1Risk Factors for Acquiring Viral Hepatitis

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