Viral hepatitis is a systemic, viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical, and cellular changes. To date, five definitive types of viral hepatitis that cause liver disease have been identified: hepatitis A, B, C, D, and E. Hepatitis A and E are similar in mode of transmission (fecal-oral route), whereas hepatitis B, C, and D share many other characteristics.
People who are at particular risk for HCV include those who use IV or injection drugs, people who are sexually active with multiple partners, patients receiving frequent transfusions, those who require large volumes of blood, and health care personnel. The incubation period is variable and may range from 15 to 160 days. The clinical course of hepatitis C is similar to that of hepatitis B; symptoms are usually mild. A chronic carrier state occurs frequently. There is an increased risk for cirrhosis and liver cancer after contracting hepatitis C. The protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis) are used for the treatment of hepatitis C genotype 1 in combination with peginterferon alpha 2-b (Peg-Intron) and ribavirin. Neither protease inhibitor may be used as monotherapy for the disease. This triple therapy of protease inhibitor, peginterferon, and ribavirin is recommended as standard treatment for hepatitis C by the American Association for the Study of Liver Diseases.
Hepatitis D (delta agent) occurs in some cases of hepatitis B. Because the virus requires hepatitis B surface antigen for its replication, only patients with hepatitis B are at risk. Hepatitis D is common among those who use IV or injection drugs, patients undergoing hemodialysis, and recipients of multiple blood transfusions. Sexual contact is an important mode of transmission of hepatitis B and D. Incubation varies between 30 and 150 days. The symptoms are similar to those of hepatitis B, except that patients are more likely to have fulminant hepatitis and progress to chronic active hepatitis and cirrhosis. Treatment is similar to that for other forms of hepatitis. Currently, interferon-alpha is the only licensed drug for the treatment of hepatitis D viral infection. The rate of recurrence is high and the efficacy of interferon is related to the dose and duration of treatment. High-dose, long-duration therapy for at least 1 year is recommended.
The hepatitis E virus (HEV) is transmitted by the fecal-oral route, principally through contaminated water and poor sanitation. Incubation is variable and is estimated to range between 15 and 65 days. In general, hepatitis E resembles hepatitis A. It has a self-limited course with an abrupt onset. Jaundice is almost always present. Chronic forms do not develop. The major method of prevention is avoiding contact with the virus through hygiene (hand washing). The effectiveness of immune globulin in protecting against hepatitis E virus is uncertain.
Hepatitis G Virus and GB Virus-C
Hepatitis G virus (HGV) and GB virus-C (GBV-C) are posttransfusion hepatitis viruses with an incubation period of 14 to 145 days. Autoantibodies are absent. The risk factors are similar to those for hepatitis C. There is no clear relationship between HGV/GBV-C infection and progressive liver disease. Persistent infection does occur but does not affect the clinical course.
For more information, see Chapter 49 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.