Introduction
- The hepatitis viruses primarily infect hepatocytes
- Taxonomy
- there are 4 important RNA hepatitis viruses
- hepatitis A (HAV)
- hepatitis C (HCV)
- hepatitis D (HDV)
- hepatitis E (HEV)
- there is 1 important DNA hepatitis virus
- hepatitis B (HBV)
- there are 4 important RNA hepatitis viruses
- Symptoms
- patients infected with hepatitis suffer from
- fever
- jaundice
- elevated ALT and AST
- ALT > AST in viral hepatitis
- AST > ALT in alcoholic hepatitis – “a Scotch and Tonic”
- patients infected with hepatitis suffer from
- Chronic vs. acute disease
- HBV and HCV can cause long-term chronic disease
- chronic active hepatitis
- cirrhosis
- hepatocellular carcinoma
- HBV and HCV can cause long-term chronic disease
- Transmission
- HAV and HEV transmitted fecal-oral
- “vowels from your bowels”
- HAV and HEV transmitted fecal-oral
- these viruses are naked and are not destroyed in the gut
Comparison chart
| HAV | HBV | HCV | HDV | HEV | |
| Family | Picornavirus | Hepadnavirus | Flavivirus | Defective | Hepevirus |
| Characteristics | Naked RNA | Enveloped DNA | Enveloped RNA | Enveloped RNA (circular) | Naked RNA |
| Disease | Mild acute No chronic | Acute Chronic (~20%) Cirrhosis Carcinoma | Acute Chronic (70%) Cirrhosis Carcinoma | Co-infection or superinfection (worse) with HBV | Mild acute No chronic |
| Transmission | Fecal-oral | Parenteral or sex | Parenteral or sex | Parenteral or sex | Fecal-oral |
| Mortality | <0.5% | 1-2% | 0.5-1% | High | 1-2% or 25% if pregnant 3rd trimester |
| Incubation period | Short (3 wks) | Long (3 mo) | Short (6-12 wks) | — | — |
| Carriers | No | Yes | Yes | Yes | No |
| Vaccine available | Yes | Yes | No (in clinical trials) | No | No (in clinical trials) |
| Remember! | A is Acute only | B is Bad (many diseases, high mortality), Big like a “great dane” | C is Chronic (leading cause for liver transplant) | D is Dependent (needs HBV to infect — HBsAg must coat HDAg) | E is Enteric in the far East (seen in Asia, not U.S.) |