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Overview of viral hepatitides

Last updated: December 19, 2023

Summarytoggle arrow icon

Viral hepatitides comprise the infectious diseases hepatitis A, B, C, D, and E, which have various routes of transmission (e.g., fecal-oral, sexual, parenteral, and perinatal transmission). Most patients are either asymptomatic or experience mild symptoms, which usually resolve spontaneously within weeks to months. However, patients with hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, or hepatitis D virus (HDV) infection may experience a chronic disease course, increasing the risk of cirrhosis and hepatocellular carcinoma (HCC). Pregnant individuals with hepatitis E virus (HEV) infection have an increased risk of developing fulminant hepatitis. Diagnostic studies include liver function tests, viral serologic testing, and measurement of viral load. Treatment of acute hepatitis primarily involves supportive care. HCV infection can be effectively treated with early direct-acting antivirals. Treatment of chronic hepatitis involves antivirals to reduce viral replication and infectivity. Vaccination is available against hepatitis A and hepatitis B.

This article contains an overview of viral hepatitides as well as hepatitis D and hepatitis E. See also “Hepatitis A,” “Hepatitis B,” and “Hepatitis C.”

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Overview of viral hepatitis
Hepatitis A virus (HAV) Hepatitis B virus (HBV) Hepatitis C virus (HCV) Hepatitis D virus (HDV) Hepatitis E virus (HEV)
Route of transmission
  • Fecal-oral
Incubation period
  • 2–6 weeks
  • 1–6 months
  • 2 weeks to 6 months
  • 2–8 weeks
Clinical course
  • Adults: acute and self-limited
  • Children: typically asymptomatic
  • Varies significantly
  • Subclinical hepatitis in 70% of cases
  • Can develop into a chronic infection

Increased risk of HCC

  • No
  • Yes
  • No
Amenable to treatment with antiviral therapy
  • No
  • Acute: no
  • Chronic: yes
  • Yes
  • Yes
  • Acute: no
  • Chronic: yes
Immunization
  • Not available
  • Not available

Vowels (A and E) are transmitted via the bowels (fecal-oral) and usually only cause AcutE hepatitis.

Hepatitis Dtoggle arrow icon

Hepatitis D virus infection [1][2]

Remember the 3 Ds of hepatitis D: Defective Deltavirus Dependent on HBV HBsAg coat for entry.

Hepatitis Etoggle arrow icon

Hepatitis E virus infection [5][6]

Women who are Expecting a child should be FULly aware of the risks: Hepatitis E can lead to FULminant hepatitis.

A fulminant course occurs in up to 20% of pregnant individuals with HEV infection; it is life-threatening for both the mother and fetus.

Referencestoggle arrow icon

  1. $Review of Pathology of the Liver: Viral Hepatitis D.
  2. Hepatitis D. http://www.who.int/mediacentre/factsheets/hepatitis-d/en/. Updated: July 1, 2017. Accessed: April 6, 2018.
  3. Negro F. Hepatitis D Virus Coinfection and Superinfection. Cold Spring Harbor Perspectives in Medicine. 2014; 4 (11): p.a021550-a021550.doi: 10.1101/cshperspect.a021550 . | Open in Read by QxMD
  4. Farci P, Niro G. Clinical Features of Hepatitis D. Semin Liver Dis. 2012; 32 (03): p.228-236.doi: 10.1055/s-0032-1323628 . | Open in Read by QxMD
  5. Hepatitis E. http://www.who.int/mediacentre/factsheets/fs280/en/. Updated: July 1, 2016. Accessed: March 24, 2017.
  6. Hepatitis E FAQs for Health Professionals. https://www.cdc.gov/hepatitis/hev/hevfaq.htm. Updated: May 31, 2015. Accessed: March 24, 2017.
  7. Park W-J, Park B-J, Ahn H-S, et al. Hepatitis E virus as an emerging zoonotic pathogen. Journal of Veterinary Science. 2016; 17 (1): p.1.doi: 10.4142/jvs.2016.17.1.1 . | Open in Read by QxMD
  8. Kamar N, Izopet J, Dalton HR. Chronic Hepatitis E Virus Infection and Treatment. Journal of Clinical and Experimental Hepatology. 2014; 3 (2): p.134-140.doi: 10.1016/j.jceh.2013.05.003 . | Open in Read by QxMD
  9. Choi M, Hofmann J, Köhler A, et al. Prevalence and Clinical Correlates of Chronic Hepatitis E Infection in German Renal Transplant Recipients With Elevated Liver Enzymes. Transplantation Direct. 2018; 4 (2): p.e341.doi: 10.1097/txd.0000000000000758 . | Open in Read by QxMD

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