Skip to main content
SpringerLink
Log in

Viral Liver Diseases

  • Living reference work entry
  • First Online:
Geriatric Gastroenterology

  • 22 Accesses

Abstract

Hepatitis A, hepatitis B, and hepatitis C are the most common types of viral hepatitis. Other types include hepatitis E and hepatitis D. Hepatitis A virus (HAV) infection can produce a significant illness in adults with severity increasing with advancing age. Once acute HAV infection resolves, patients develop lifelong immunity. Hepatitis E virus (HEV) is similar to HAV, but acute infection causes higher mortality in older adults. Hepatitis B virus (HBV) is one of the most common infections in the world and a leading cause of liver cancer. Majority of adult patients with acute HBV spontaneously clear the infection. Five percent of patients, however, progress into chronic hepatitis B. Chronic HBV is a dynamic disease with four phases: HBe antigen positive immune tolerance and immune clearance phases; and HBe antigen negative inactive and reactivation phases. Most chronic HBV encountered in older patients are “E antigen” negative/E antibody positive chronic HBV. Treatment of chronic HBV is indicated when there is evidence of liver injury based on elevated ALT and advanced fibrosis on liver biopsy. Entecavir or tenofovir are the currently approved treatments and both have excellent safety and efficacy. HCV is the one of the leading indications for liver transplant in the United States and Europe. Most patients, who get infected with HCV, develop chronic HCV with many eventually progressing to cirrhosis. Screening is recommended for people born between 1945 and 1965 irrespective of risk factors; this screening recommendation may be expanded further to all adults in the near future. Specific drugs targeting HCV replication can cure most patients and hence treatment is recommended if there is detectable HCV RNA.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

HAV:

Hepatitis A virus

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HDV:

Hepatitis D virus

HEV:

Hepatitis E virus

HIV:

Human immunodeficiency virus

IgG:

Immunoglobulin G

IgM:

Immunoglobulin M

NS3A/4:

Nucleoside 3A/4

NS5A:

Nucleoside 5A

NS5B:

Nucleoside 5B

PCR:

Polymerase chain reaction

RAS:

Resistance-associated substitutions

RNA:

Ribonucleic acid

SVR:

Sustained virologic response

References

  • Bell BP, Kruszon-Moran D, Shapiro CN, Lambert SB, McQuillan GM, Margolis HS. Hepatitis A virus infection in the United States: serologic results from the Third National Health and Nutrition Examination Survey. Vaccine. 2005;23(50):5798–806.

    Article  Google Scholar 

  • Chen G, Wang C, Chen J, Ji D, Wang Y, Wu V, Karlberg J, Lau G. Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: a systematic review and meta-analysis. Hepatology. 2017;66(1):13–26.

    Article  CAS  Google Scholar 

  • Conjeevaram HS, Wahed AS, Afdhal N, Howell CD, Everhart JE, Hoofnagle JH, Virahep CSG. Changes in insulin sensitivity and body weight during and after peginterferon and ribavirin therapy for hepatitis C. Gastroenterology. 2011;140(2):469–77.

    Article  CAS  Google Scholar 

  • Daniels D, Grytdal S, Wasley A. Centers for disease C, prevention: surveillance for acute viral hepatitis – United States, 2007. MMWR Surveill Summ. 2009;58(3):1–27.

    PubMed  Google Scholar 

  • Davis GL, Balart LA, Schiff ER, Lindsay K, Bodenheimer HC Jr, Perrillo RP, Carey W, Jacobson IM, Payne J, Dienstag JL, et al. Treatment of chronic hepatitis C with recombinant interferon alfa. A multicenter randomized, controlled trial. N Engl J Med. 1989;321(22):1501–6.

    Article  CAS  Google Scholar 

  • Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, Holmberg SD. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160(5):293–300.

    Article  Google Scholar 

  • Eslam M, Khattab MA, Harrison SA. Insulin resistance and hepatitis C: an evolving story. Gut. 2011;60(8):1139–51.

    Article  CAS  Google Scholar 

  • FDA approves Mavyret for Hepatitis C. In

    Google Scholar 

  • FDA approves Sovaldi for chronic hepatitis C. https://www.hhs.gov/hepatitis/blog/2013/12/09/fda-approves-sovaldi-for-chronic-hepatitis-c.html

  • Feld JJ, Jacobson IM, Hezode C, Asselah T, Ruane PJ, Gruener N, Abergel A, Mangia A, Lai CL, Chan HL, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–607.

    Article  CAS  Google Scholar 

  • Forbes A, Williams R. Increasing age – an important adverse prognostic factor in hepatitis A virus infection. J R Coll Physicians Lond. 1988;22(4):237–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Forns X, Lee SS, Valdes J, Lens S, Ghalib R, Aguilar H, Felizarta F, Hassanein T, Hinrichsen H, Rincon D, et al. Glecaprevir plus pibrentasvir for chronic hepatitis C virus genotype 1, 2, 4, 5, or 6 infection in adults with compensated cirrhosis (EXPEDITION-1): a single-arm, open-label, multicentre phase 3 trial. Lancet Infect Dis. 2017;17(10):1062–8.

    Article  CAS  Google Scholar 

  • Foster GR, Afdhal N, Roberts SK, Brau N, Gane EJ, Pianko S, Lawitz E, Thompson A, Shiffman ML, Cooper C, et al. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. N Engl J Med. 2015;373(27):2608–17.

    Article  CAS  Google Scholar 

  • Gisbert JP, Chaparro M, Esteve M. Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33(6):619–33.

    Article  CAS  Google Scholar 

  • Jacobson IM, Cacoub P, Dal Maso L, Harrison SA, Younossi ZM. Manifestations of chronic hepatitis C virus infection beyond the liver. Clin Gastroenterol Hepatol. 2010;8(12):1017–29.

    Article  Google Scholar 

  • Jacobson IM, Lawitz E, Gane EJ, Willems BE, Ruane PJ, Nahass RG, Borgia SM, Shafran SD, Workowski KA, Pearlman B, et al. Efficacy of 8 weeks of sofosbuvir, velpatasvir, and voxilaprevir in patients with chronic HCV infection: 2 phase 3 randomized trials. Gastroenterology. 2017;153(1):113–22.

    Article  CAS  Google Scholar 

  • Li SW, Zhao Q, Wu T, Chen S, Zhang J, Xia NS. The development of a recombinant hepatitis E vaccine HEV 239. Hum Vaccin Immunother. 2015;11(4):908–14.

    Article  Google Scholar 

  • Liaw YF, Sheen IS, Lee CM, Akarca US, Papatheodoridis GV, Suet-Hing Wong F, Chang TT, Horban A, Wang C, Kwan P, et al. Tenofovir disoproxil fumarate (TDF), emtricitabine/TDF, and entecavir in patients with decompensated chronic hepatitis B liver disease. Hepatology. 2011;53(1):62–72.

    Article  CAS  Google Scholar 

  • Lin CL, Kao JH. The clinical implications of hepatitis B virus genotype: recent advances. J Gastroenterol Hepatol. 2011;26(Suppl 1):123–30.

    Article  Google Scholar 

  • McHutchison JG, Gordon SC, Schiff ER, Shiffman ML, Lee WM, Rustgi VK, Goodman ZD, Ling MH, Cort S, Albrecht JK. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med. 1998;339(21):1485–92.

    Article  CAS  Google Scholar 

  • Morgan TR, Ghany MG, Kim HY, Snow KK, Shiffman ML, De Santo JL, Lee WM, Di Bisceglie AM, Bonkovsky HL, Dienstag JL, et al. Outcome of sustained virological responders with histologically advanced chronic hepatitis C. Hepatology. 2010;52(3):833–44.

    Article  CAS  Google Scholar 

  • Patel K, Thompson AJ, Chuang WL, Lee CM, Peng CY, Shanmuganathan G, Thongsawat S, Tanwandee T, Mahachai V, Pramoolsinsap C, et al. Insulin resistance is independently associated with significant hepatic fibrosis in Asian chronic hepatitis C genotype 2 or 3 patients. J Gastroenterol Hepatol. 2011;26(7):1182–8.

    Article  CAS  Google Scholar 

  • Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349(9055):825–32.

    Article  CAS  Google Scholar 

  • Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis c. J Hepatol. 2001;34(5):730–9.

    Article  CAS  Google Scholar 

  • Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55(4):988–97.

    Article  Google Scholar 

  • Swain MG, Lai MY, Shiffman ML, Cooksley WG, Zeuzem S, Dieterich DT, Abergel A, Pessoa MG, Lin A, Tietz A, et al. A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. Gastroenterology. 2010;139(5):1593–601.

    Article  CAS  Google Scholar 

  • Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, Brown RS Jr, Bzowej NH, Wong JB. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–99.

    Article  Google Scholar 

  • Thabut D, Le Calvez S, Thibault V, Massard J, Munteanu M, Di Martino V, Ratziu V, Poynard T. Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease? Am J Gastroenterol. 2006;101(6):1260–7.

    Article  Google Scholar 

  • Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G, Ferraro T, Concia E. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med. 1998;338(5):286–90.

    Article  CAS  Google Scholar 

  • Wedemeyer H, Yurdaydin C, Dalekos GN, Erhardt A, Cakaloglu Y, Degertekin H, Gurel S, Zeuzem S, Zachou K, Bozkaya H, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med. 2011;364(4):322–31.

    Article  CAS  Google Scholar 

  • WHO. Combating hepatitis B and C to reach elimination by 2030. Advocacy brief. 2016. https://www.who.int/hepatitis/publications/hep-elimination-by-2030-brief/en/

  • World Health Organization. Hepatitis E fact sheet. http://www.who.int/news-room/fact-sheets/detail/hepatitis-e

  • Yuen MF, Lai CL. Treatment of chronic hepatitis B: evolution over two decades. J Gastroenterol Hepatol. 2011;26(Suppl 1):138–43.

    Article  Google Scholar 

  • Zeuzem S, Feinman SV, Rasenack J, Heathcote EJ, Lai MY, Gane E, O’Grady J, Reichen J, Diago M, Lin A, et al. Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med. 2000;343(23):1666–72.

    Article  CAS  Google Scholar 

  • Zeuzem S, Foster GR, Wang S, Asatryan A, Gane E, Feld JJ, Asselah T, Bourliere M, Ruane PJ, Wedemeyer H, et al. Glecaprevir-pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection. N Engl J Med. 2018;378(4):354–69.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Director of Liver Transplantation, Endowed Chair of Excellence in Transplant Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Satheesh Nair

  2. Division of Transplant Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA

    Rajanshu Verma

Authors
  1. Satheesh Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajanshu Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satheesh Nair .

Editor information

Editors and Affiliations

  1. Saint Peter's Healthcare System, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Nair, S., Verma, R. (2020). Viral Liver Diseases. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_50-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90761-1_50-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90761-1

  • Online ISBN: 978-3-319-90761-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation