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. HAV does not cause chronic infection and treatment is supportive. Up to 1.4 million persons in the USA and 350 million worldwide are infected with HBV. The majority of adult patients with acute HBV spontaneously clear the infection. Five percent of patients, however, progress into chronic hepatitis B. The natural history of chronic HBV infection includes four phases: immune tolerance, immune clearance, inactive carrier state, and reactivation. Most chronic HBV encountered in older patients is in the form of “e antigen”-negative chronic HBV. Treatment of HBV is mainly indicated in the immune clearance and reactivation phase. Entecavir and tenofovir have the best profile in terms of safety, potency, and genetic barrier to resistance. Hepatitis C virus (HCV) is the leading indication for liver transplant in the USA and Europe. Most patients who get infected with HCV develop chronic HCV with 25–30% of them progressing to cirrhosis. Liver biopsy and genotype (types 1, 2, or 3) are important when deciding on treatment. Pegylated interferon alpha in combination with ribavirin and a protease inhibitor is the current available therapy for HCV. Several new directly acting agents are in clinical trials and will substantially increase the response rate in HCV.
KeywordsSustained Virologic Response Pegylated Interferon Alpha
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