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Viral Hepatitis
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Causes of Acute Hepatitis
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Causes of Chronic Hepatitis
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Hepatitis A
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Global Prevalence of Hepatitis A Infection
HAV Prevalence High Intermediate Low Very Low Global Prevalence of Hepatitis A Infection 16 6
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Hepatitis B
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Hepatitis B Virus HBsAg HBV DNA HBcAg 42 nm Hepadnaviridae ; Genus : orthohepadnavirus : member that primarily infects liver cells 50 to 100 times more infective than HIV Multiple genotypes exist (A-H) DNA virus found in blood and body fluids Able to survive in dried blood for longer than 1 week 8
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Geographic Distribution of Chronic HBV Infection
> 350 million carriers (HBsAg + > 6 months) 10th cause of death (1 million / year) Cirrhosis in 20% ( million) HCC in % ( million) HBsAg Prevalence 8% - High 2-7% - Intermediate <2% - Low
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HBV Sources of Infection
Household, 3% MSM, 23% Other, 23% Sex contact, 23% IDU, 20% Multiple sex partners, 24% Many patients do not reveal IDU as source of infection Centers for Disease Control and Prevention. Hepatitis B. In: Atkinson W et al, eds. Epidemiology & Prevention of Vaccine-Preventable Diseases. 8th ed Washington DC: Public Health Foundation; 2005: 10
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Hepatitis B: Disease Progression
Liver Cancer (HCC) 5%-10% 1 2-6% Acute Infection Chronic Infection Liver Transplantation Death Cirrhosis 10-30% 1 90% in perinatal 30-90% in children<5yrs old 5% in healthy adults Higher in HIV, immune suppressed Chronic HBV is the 6th leading cause of liver transplantation in the US4 Liver Failure (Decompensation) 23% within 5 years 1. Torresi J et al. Gastroenterology 2. Fattovich G et al. Hepatology 3. Moyer LA et al. Am J Prev Med 4. Perrillo R et al. Hepatology 11
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Typical Serologic Course
Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic (Years) HBeAg anti-HBe HBsAg Total anti-HBc Titer HBV DNA IgM anti-HBc 4 8 12 16 20 24 28 32 36 52 Years Weeks after Exposure
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Course of Acute HCV Infection
1000 HCV RNA positive Anti-HCV 800 Symptoms 600 ALT (IU/L) 400 200 Normal ALT 2 4 6 8 10 12 24 1 2 3 4 5 6 7 Weeks Months Time After Exposure Hoofnagle JH. Hepatology. 1997;26:15S. Carithers RL Jr, et al. Semin Liver Dis ;20: Pawlosky JM. Hepatology. 2002;36(suppl 1):S65-S73. NIH Management of Hepatitis C Consensus Conference Statement. June 10-12, Available at: Accessed April 10, 2007. 13 13
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Symptoms, or Lack of, in Chronic HCV Infection
Symptomatic 37% 100 Cirrhosis 7% 80 80 60 Patients (%) 40 20 Fatigue 56% Asymptomatic 14 14
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Prevalence of HCV Dependant on Risk Factors
Hemophilia % IVDA % Prison 40% HIV % Blood transfusion prior to % Infants to HCV+ Mothers 5% Sexual Partner % General Population 1.8% Adapted from MMWR.1998;47:5.
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HCV: Disease Progression
Time: years HCV infection 60-85%1 Chronic HCV Cirrhosis Hepatic Failure 20%-50%2 ~ 20%3 ~20%4 Liver Transplant Candidates Liver Cancer 1. NIH Consensus Development Conference Statement; March 24-26, 1997. 2. Davis GL et al. Gastroenterol Clin North Am. 1994;23: 3. Koretz RL et al. Ann Intern Med. 1993;119: 4. Takahashi M et al. Am J Gastroenterol. 1993;88: 36 16
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