Infectious DiseasesTier 2Disease (DEADMAN)

Hepatitis viruses

Description

The hepatitis viruses (A-E) share hepatotropism but differ substantially in transmission route, chronicity risk, and clinical significance - hepatitis A and E are predominantly faeco-orally transmitted and essentially always self-limiting, while hepatitis B, C, and D (a defective virus requiring hepatitis B co-infection) are bloodborne/sexually transmitted with meaningful chronic infection risk

Epidemiology

Collectively responsible for a large global burden of acute and chronic liver disease, with hepatitis B and C the dominant contributors to chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide

Aetiopathogenesis

Chronicity risk differs by virus and, for hepatitis B specifically, by age at infection (much higher chronicity risk with perinatal/early childhood infection than adult-acquired infection) - reflecting differences in the developing versus mature immune response's ability to clear the virus

Diagnosis

See , , , and for virus-specific diagnostic testing and serological interpretation
Hepatitis D testing should be considered in any hepatitis B-positive patient with unexpectedly severe or progressive disease, given its dependence on hepatitis B co-infection for replication

Management

Hepatitis A/E: supportive care only, given essentially universal self-limiting course in immunocompetent hosts
Hepatitis B/C: antiviral treatment (nucleos(t)ide analogues for B, direct-acting antivirals for C - the latter now curative in the large majority of cases) guided by viral load, genotype (for C), and fibrosis staging

Associations

Hepatocellular carcinoma risk (chronic B/C, requiring surveillance), vertical transmission (hepatitis B - perinatal transmission risk and neonatal immunoprophylaxis), hepatitis D superinfection/coinfection with hepatitis B

Natural history & complications

Chronicity risk for hepatitis B is age-dependent, not fixed - perinatal/early childhood infection carries a much higher risk of chronic infection than infection acquired as an immunocompetent adult, which is why perinatal transmission prevention (maternal screening, neonatal immunoprophylaxis) is such a high-yield public health intervention

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