Caused by 29- to 32-nm agent resembling caliciviruses but considered within its own genus, Hepevirus. Enterically transmitted and responsible for waterborne epidemics of hepatitis in India, parts of Asia and Africa, and Central America. Self-limited illness with high (10-20%) mortality rate in pregnant women.
Treatment: Viral Hepatitis Activity as tolerated, high-calorie diet (often tolerated best in morning), IV hydration for severe vomiting, cholestyramine up to 4 g PO four times daily for severe pruritus, avoid hepatically metabolized drugs; no role for glucocorticoids. Liver transplantation for fulminant hepatic failure. In rare instances of severe acute HBV, treatment with a nucleoside analogue has been used successfully. Most authorities would recommend antiviral therapy for severe acute HBV (Chap. 153. Chronic Hepatitis). For acute HCV, in places where directly acting antivirals are available, delay in treatment initiation for up to 6 months with counseling and monitoring of HCV RNA levels are recommended. The same regimens that are recommended for treatment naïve pts with chronic HCV infection can then be used for acute infection (Chap. 153. Chronic Hepatitis). |