Hepatitis

The five known causes of acute hepatitis are the hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV) viruses.Hepatitis A and E are forms of infectious hepatitis which spread largely by the fecal-oral route, occur in outbreaks a well as sporadically.Hepatitis B, C and D are forms of serum hepatitis, are spread largely by parenteral routes and less commonly by sexual exposure and occur sporadically and rarely cause outbreaks.Acute hepatitis B and C capable of leading to chronic hepatitis 10% and 80% retrospectively.Highlights of Hepatitis B: The spectrum of clinical manifestations range from subclinical or anicteric hepatitis to icteric hepatitis and, in some cases, fulminant hepatitis; during the chronic phase, manifestations range from an asymptomatic carrier state to chronic hepatitis, cirrhosis, and hepatocellular carcinoma.Approximately 70 percent of patients with acute hepatitis B have subclinical or anicteric hepatitis, while 30 percent develops icteric hepatitis.The sequelae of chronic HBV infection vary from an inactive carrier state to the development of cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), extrahepatic manifestations, and death.In patients with acute hepatitis B, we suggest treatment with a nucleoside/tide analogue in those who have severe hepatitis [such as those who develop a coagulopathy (INR > 1.5)] or a protracted course (such as persistent symptoms or marked jaundice [bilirubin >10 mg/dl] for more than four weeks after presentation)Treatment of chronic hepatitis B if indicated are as: conventional IFNα2α, PegIFNα2α (Pegasys) or oral nucleotide/tide included: Lamivudine, Adefuir Tenofovir, Entecavir, Telbivudin.Highlights of Hepatitis C: Infection with the hepatitis C virus (HCV) can result in both acute and chronic hepatitis. The acute process is most often asymptomatic; if symptoms are present, they usually abate within a few weeks. Acute infection rarely causes hepatic failure. The risk of chronic infection after an acute episode of hepatitis C is high. In most studies, 80 to 100 percent of patients remain HCV RNA positive, and 60 to 80 percent have persistently elevated liver enzymes.Most patients with chronic infection are asymptomatic or have only mild nonspecific symptoms.Treatment of choice, If indicated is: Combination therapy including: IFNα2α (Pegasys) + Ribavirin