Definition
Viral hepatitis refers to the clinically important hepatotrophic viruses responsible for hepatitis A, hepatitis B, delta hepatitis, hepatitis C, and hepatitis E. Viral hepatitis has acute, fulminant, and chronic clinical forms defined by duration or severity of infection.
Acute viral hepatitis is a systemic viral infection of up to but not exceeding 6 months in duration that produces inflammatory necrosis of the liver. Chronic viral hepatitis describes prolongation or continuation of the hepatic necroinflammatory process 6 months or more beyond the onset of the acute illness.
Hepatitis A
Hepatitis B
Hepatitis C
Chronic hepatitis as a consequence of hepatitis C has reached epidemic proportions worldwide.
Hepatitis C is most often acquired through intravenous drug use; sexual contact; hemodialysis; or household, occupational, or perinatal exposure.
Patients with acute hepatitis C are often asymptomatic. The clinical course is generally mild with less than 25% of patients developing malaise, anorexia, and jaundice.
Serum transaminase values are elevated within 4 to 12 weeks after exposure.
Seventy percent of cases eventually develop chronic hepatitis.
Ten percent to 30% of patients with hepatitis C infection develop cirrhosis, 1% to 5% develop hepatocellular carcinoma.
Treatment
The goal of treating hepatitis C is to return the individual to the previous state of health and prevent development of chronic infection, which can lead to morbidity and mortality from end-stage liver disease.
Management of acute hepatitis C is primarily supportive. General measures include a healthy diet, rest, maintenance of fluid balance, and avoidance of hepatotoxic drugs and alcohol.
Patients seropositive for hepatitis C with elevated alanine transaminase and inflammation on liver biopsy are candidates for antiviral therapy.
First-line treatment for acute hepatitis C includes pegylated interferon plus ribavirin. The dosing regimen varies with the specific product and the duration of therapy varies with the product and hepatitis C genotype.
Prevention
No hepatitis C vaccine is currently available.
Current recommendations for prevention of hepatitis C include universal precautions for the prevention of blood-borne infections and anti-hepatitis C screening of blood, organ, and tissue donors.
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