Hepatitis Viruses

Viral infections are the primary cause of hepatitis, or inflammation of the liver. Classic hepatotropic viruses, hepatitis A through E, are the most common cause of hepatitis, although other infectious agents are able to infect the liver. These infections differ in their route of transmission and clinical presentation and cause a range of hepatic injury from mild and transient elevation of aminotransaminases to fulminant hepatitis and liver failure. Acute hepatitis is characterized by nonspecific viral syndromes as well as variable evidence of hepatic inflammation. Certain hepatotropic viruses, particularly HBV and HCV, can also cause chronic infection, which is often clinically inapparent for many years until the development of significant fibrosis or cirrhosis resulting in an increased risk of hepatocellular carcinoma and liver failure. Certain patient populations, including people with HIV or other immunosuppression, are at particular risk of poor outcomes with viral hepatitis. In this chapter, we describe the clinical presentations, diagnostic and therapeutic testing, treatment and prevention of the classic hepatotropic viruses, as well as common clinical scenarios and mimics of viral hepatitis.