Hepatitis A, B, and C

1. John C. Christenson, MD* 2. John J. Manaloor, MD* 1. *Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN. Because hepatitis A, B, and C viruses are responsible for substantial morbidity and mortality, clinicians must learn to recognize, treat and prevent infections caused by these viruses. After completing this article, readers should be able to: 1. Describe the epidemiology of hepatitis A, B, and C virus infections. 2. Recognize the clinical features of hepatitis A infection. 3. Appropriately administer vaccines for the prevention of hepatitis A and B infection. 4. Recognize the various antiviral regimens used for the treatment of hepatitis B and C liver disease. 5. Order the most appropriate tests for the diagnosis of hepatitis virus infections. During the past 30 years, the understanding of hepatitis viruses has greatly expanded. Knowledge of hepatitis has progressed from merely describing the various clinical syndromes to a greater understanding of the pathogenesis of disease caused by these viruses and the development of chronic infection that eventually leads to cirrhosis or hepatocellular carcinoma. Expanded understanding also has led to the development of effective vaccines against hepatitis A virus (HAV) and hepatitis B virus (HBV) and antiviral therapies against hepatitis C virus (HCV). The introduction of routine vaccination against HAV and HBV starting in early childhood in the United States has resulted in a substantial decrease in both of these infections in children and the subsequent complications of HBV-related chronic liver disease. Effective screening of mothers during pregnancy and the administration of HBV vaccine soon after birth, along with administration of hepatitis B immune globulin (HBIG) to infants born to women who have HBV infection, has led to near eradication of perinatally acquired HBV disease in the United States and other countries with effective screening programs. The introduction …