Viral Hepatitis Questions & Answers

Updated: Jun 12, 2017
  • Author: Naga Swetha Samji, MD; Chief Editor: BS Anand, MD  more...
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Questions & Answers

Overview

What is hepatitis?

Which viruses cause viral hepatitis?

What are the possible presentations of viral hepatitis?

What are the signs and symptoms of acute hepatitis?

What is the prevalence of fulminant hepatic failure (FHF) in viral hepatitis and how is it characterized?

What is the likelihood of acute viral hepatitis progressing to chronic hepatitis?

How frequently is cirrhosis or hepatocellular carcinoma caused by chronic hepatitis?

What is the prognosis of chronic hepatitis-induced cirrhosis?

What is the pathophysiology of hepatitis A virus (HAV) infection?

What causes liver damage in the pathogenesis of hepatitis B virus (HBV) infection?

What is the pathophysiology of hepatitis B virus (HBV) infection?

What is the pathophysiology of chronic hepatitis?

What is the pathogenesis of hepatitis B virus (HBV)-induced cirrhosis?

What is the pathophysiology of hepatitis C virus (HCV) infection?

How does comorbid hepatitis D virus (HDV) and hepatitis B virus (HBV) infections affect the disease course?

What is the pathophysiology of hepatitis E virus (HEV) infection?

Which strains of hepatitis cause the majority of viral hepatitis?

What are the typical patterns of hepatitis virus transmission?

What is the etiology of hepatitis A virus (HAV) and which groups are at increased risk for infection?

What is hepatitis B virus (HBV)?

What antigens are contained in the hepatitis B virus (HBV) and how are they detected?

How many hepatitis B virus (HBV) genotypic variants have been identified?

How is hepatitis B virus (HBV) detected?

How many people in the US are infected with hepatitis B virus (HBV)?

How is hepatitis B virus (HBV) transmitted?

What is the risk of hepatitis B virus (HBV) infection in children of antigen (HBeAg) negative women?

Which groups are at a high risk for hepatitis B virus (HBV) infection?

What is the genetic morphology of hepatitis C virus (HCV)?

How is hepatitis C virus (HCV) transmitted?

Which genetic polymorphisms affect hepatitis C virus (HCV) clearance?

What is the genetic morphology of hepatitis D virus (HDV) and what are its modes of transmission?

What is the genetic morphology of hepatitis E virus (HEV) and what are its modes of transmission?

What is the genetic morphology of hepatitis G virus (HGV) and what are its modes of transmission?

What is the incidence of healthcare-associated hepatitis B outbreaks?

What is the incidence of viral hepatitis in the US?

What is the prevalence of viral hepatitis globally?

In what regions is hepatitis A virus (HAV) most prevalent?

What is the prevalence of the hepatitis B virus (HBV) infection?

How is hepatitis B virus (HBV) transmitted to infants?

How is hepatitis B virus (HBV) transmitted between sexual partners?

How is hepatitis B virus (HBV) transmitted parenterally?

How frequently is the cause of hepatitis B virus (HBV) infection unknown?

What is the prevalence of hepatitis C virus (HCV) infection?

How much has screening of the US blood supply reduced the incidence of hepatitis C virus (HCV) infections?

What percentage of new hepatitis C virus (HCV) infections are caused by IV and intranasal drug use?

What percentage of new hepatitis C virus (HCV) infections are occupational exposure in healthcare workers?

What are the US Public Health Service recommendations for individuals with hepatitis C virus (HCV) infection and their sexual partners?

What are the risk factors for perinatal transmission of hepatitis C virus (HCV)?

What is the risk of healthcare-related hepatitis C transmission?

What is the prevalence of D virus (HDV) infection in patients with acute hepatitis B?

How is hepatitis E virus (HEV) transmitted?

How does the prognosis of viral hepatitis vary?

What are the risks for chronic hepatitis B virus (HBV) infection in older children and adults?

What is the mortality risk for chronic hepatitis C?

What is the prognosis of coinfection with hepatitis B virus (HBV) and hepatitis D virus (HDV)?

What is the prognosis of hepatitis E virus (HEV) infections?

What are possible complications of viral hepatitis?

What are the complications of hepatitis B virus (HBV) infection?

What are the complications of hepatitis C virus (HCV) infection?

What are the extrahepatic complications of hepatitis C virus (HCV) infection?

What information about viral hepatitis should patients receive?

Presentation

What are the signs and symptoms of viral hepatitis?

What are the signs and symptoms of hepatitis A virus (HAV) infection?

What are the signs and symptoms of acute hepatitis B virus (HBV) infection?

What are the signs and symptoms of hepatitis C virus (HCV) infection?

What are the signs and symptoms of hepatitis D virus (HDV) infection?

What are the signs and symptoms of hepatitis E virus (HEV) infection?

What are the physical finding of viral hepatitis?

DDX

Which conditions should be included in the differential diagnoses of viral hepatitis?

What are the differential diagnoses for Viral Hepatitis?

Workup

What can be done to identify a patient with suspected viral hepatitis?

What is the role of bilirubin and alkaline phosphatase testing in the evaluation of viral hepatitis?

What does prolonged prothrombin time (PT) indicate in the evaluation of viral hepatitis?

How is acute hepatitis A virus (HAV) infection diagnosed?

How is acute hepatitis B virus (HBV) infection diagnosed?

How is a diagnosis of hepatitis C virus (BCV) infection confirmed?

What is the role of immunoglobulin M (IgM) antibody testing in the evaluation of viral hepatitis?

What is the role of imaging studies in the diagnosis of viral hepatitis?

What is the role of liver biopsy in the diagnosis of viral hepatitis?

How is acute hepatitis A virus (HAV) infection documented?

What is the earliest serum marker seen in acute hepatitis B virus (HBV) infection?

What is the first antibody to appear in hepatitis B virus (HBV) infection?

What finding indicates that hepatitis B virus (HBV) infection has been cleared?

How should serology findings from acute hepatitis B virus (HBV) infection be interpreted?

What is indicated in a finding of anti-HBc (total) with a negative hepatitis B surface Ag (HBsAg) and anti-HBs?

What is the role of PCR in the evaluation of viral hepatitis?

Which antibody findings indicate hepatitis B virus (HBV) carrier status?

What does a finding of anti-HBs in chronic hepatitis infection indicate?

What tests are included in the workup of hepatitis B virus (HBV) infection?

How does HBV vaccine protect against hepatitis B?

How are extrahepatic complications of hepatitis C virus (HCV) infection prevented?

What tests are included in the workup of hepatitis C virus (HCV) infection, and what are the CDC recommendations for HCV screening?

What finding indicates the presence of liver injury in hepatitis C virus (HCV) infection?

How are structural and nonstructural regions of hepatitis C virus (HCV) genome recognized?

What is the role of anti-hepatitis C virus (HCV) testing in the diagnosis of viral hepatitis?

What is the OraQuick hepatitis C virus (HCV) Rapid Antibody Test?

What is the role of recombinant immunoblot assays (RIBAs) in the evaluation of hepatitis C virus (HCV) infection?

How should positive hepatitis C virus (HCV) results from ELISA or RIBA testing be interpreted?

What are the limitations of ELISA testing for hepatitis C virus (HCV) infection?

What is the role of HCV RNA testing in the diagnosis of hepatitis C virus (HCV) infection?

What is the role of liver biopsy in the diagnosis of chronic hepatitis C virus (HCV) infection?

What is the role of hepatic fibrosis assessment in the diagnosis of hepatitis C virus (HCV) infection?

How might a finding of severe histologic changes influence the management of hepatitis C virus (HCV) infection?

What are the treatment options for hepatitis C virus (HCV) infection with minimal fibrosis on biopsy?

What are the limitations of liver biopsy in the evaluation of hepatitis C virus (HCV) infection?

How is liver stiffness estimated in the evaluation of hepatitis C virus (HCV) infection?

How is liver fibrosis estimated in hepatitis C virus (HCV) infection?

What is the role of serologic fibrosis markers in the evaluation of hepatitis C virus (HCV) infection?

How is hepatitis delta virus (HDV) infection diagnosed?

How is hepatitis E virus (HEV) infection diagnosed?

Which histologic findings are characteristic of hepatitis B virus (HBV) infection?

What are the histologic scoring systems used to grade hepatitis C virus (HCV) infection?

What is the histologic staging for hepatitis C virus (HCV) infection–induced liver disease?

What are the classic histologic findings of hepatitis C virus (HCV) infection?

Which histologic findings are characteristic of hepatitis delta virus (HDV) infection?

What are the classic histologic findings of hepatitis E virus (HEV) infection?

Treatment

How should viral hepatitis be treated in the ED?

When is hospitalization indicated for treatment of viral hepatitis?

What are the goals of therapy in chronic viral hepatitis?

How is viral hepatitis monitored?

What are the treatment options for acute hepatitis A virus (HAV) infection?

What are the treatment options for acute hepatitis B virus (HBV) infection?

What is the goal for treatment of chronic hepatitis B virus (HBV) infection?

What are the goals of antiviral treatment in hepatitis B virus (HBV) infection?

Which medications are used to treat hepatitis B?

How is acute hepatitis C virus (HCV) infection treated?

What are the goals of antiviral therapy for hepatitis C virus (HCV) infection?

What is the role of interferon (IFN) in the treatment of hepatitis C virus (HCV) infection?

What is the efficacy of interferon (IFN)-based therapy in the treatment of hepatitis C virus (HCV) infection?

Why must the goals of therapy align with the stage of hepatitis C virus (HCV) disease?

What are interferons (IFNs), and how are they used in the treatment of chronic hepatitis C virus (HCV) infection?

What is the most commonly used medication for chronic hepatitis C virus (HCV) infection in the US?

What interferons (IFNs) are being investigated for the treatment of chronic hepatitis C virus (HCV) infection?

What are the predictive factors for sustained virologic response (SVR) to treatment in hepatitis C virus (HCV) infection?

What factor improves the prognosis of liver transplantation to treat hepatitis C–related cirrhosis?

What are the adverse effects of interferon (IFN) treatment for hepatitis C virus (HCV) infection?

What maximizes the likelihood of achieving sustained virologic response (SVR) in the treatment of chronic hepatitis C virus (HCV) infection?

How is neutropenia managed in chronic hepatitis C virus (HCV) infection?

How is thrombocytopenia managed in chronic hepatitis C virus (HCV) infection?

What is the role of eltrombopag in the treatment of chronic hepatitis C virus (HCV) infection?

What are adverse effects of ribavirin in the treatment of chronic hepatitis C virus (HCV) infection?

Why should patients with chronic hepatitis C virus (HCV) infection undergo pretreatment and posttreatment ophthalmologic exams?

How does insulin resistance affect treatment for chronic hepatitis C virus (HCV) infection?

How well is combination therapy for chronic hepatitis C virus (HCV) infection tolerated?

How is treatment of chronic hepatitis C virus (HCV) infection affected by comorbid renal conditions?

How prevalent is comorbid hepatitis C virus (HCV) infection and HIV infection?

What is the importance of direct-acting antiviral drugs (DAAs) in the treatment of chronic hepatitis C virus (HCV) infection?

What are some examples of newer, all oral, direct-acting antiviral agents (DAAs) in the treatment of chronic hepatitis C virus (HCV) infection?

What are treatment options for hepatitis B virus (HBV) and hepatitis delta virus (HDV) coinfection?

How is hepatitis A virus (HAV) infection prevented?

Who should be vaccinated against hepatitis A virus (HAV)?

How is the hepatitis A virus (HAV) vaccine administered?

When should a booster dose of the hepatitis A virus (HAV) vaccine be administer?

Which vaccine is effective against both c hepatitis A virus (HAV) and hepatitis B virus (HBV)?

When is postexposure immunization against hepatitis A virus (HAV) indicated?

What are the primary strategies for the prevention of hepatitis B virus (HBV) infection?

What are the recommendations for vaccination against hepatitis B virus (HBV)?

How is vertical transmission of hepatitis B virus (HBV) prevented?

What is the role of hepatitis B immune globulin (HBIG) in the prevention of hepatitis B virus (HBV) infection?

What are the recommendations for postexposure hepatitis B virus (HBV) prophylaxis?

What factors may improve outcomes for patients with hepatitis B virus (HBV) infection?

How is hepatitis C virus (HCV) infection prevented?

What factors may improve outcomes in patients with hepatitis C virus (HCV) infection?

Which groups should be screened for hepatitis C virus (HCV)?

How is the transmission of hepatitis delta virus (HDV) prevented?

How is hepatitis E virus (HEV) infection prevented?

Medications

What are the goals of pharmacologic therapy for chronic hepatitis B?

Which medications are used to treat chronic hepatitis B virus (HBV) infection?

How is chronic hepatitis C virus (HCV) infection treated?

What are some other treatments under investigation for chronic hepatitis C virus (HCV) infection?

Which medications in the drug class Immune Globulins are used in the treatment of Viral Hepatitis?

Which medications in the drug class Vaccines, Viral, Prevention are used in the treatment of Viral Hepatitis?

Which medications in the drug class Corticosteroids are used in the treatment of Viral Hepatitis?

Which medications in the drug class Antivirals are used in the treatment of Viral Hepatitis?

Which medications in the drug class Interferons are used in the treatment of Viral Hepatitis?