Description

Hepatitis viruses are a group of distinct, hepatotropic viruses that cause acute and/or chronic liver inflammation, leading to outcomes ranging from self-limited illness to cirrhosis, liver failure, and hepatocellular carcinoma (HCC). The major clinically relevant types are Hepatitis A, B, C, D, and E, each with unique transmission routes, natural history, and management considerations. Overview by Virus Type Hepatitis A (HAV)

• Virus: Non-enveloped RNA (Picornaviridae)
• Transmission: Fecal–oral (contaminated food/water)
• Course: Acute, self-limited, no chronic infection
• Key points:
  • More severe in adults
  • Lifelong immunity after infection or vaccination
• Prevention: Highly effective vaccine; post-exposure vaccination or immune globulin

Hepatitis B (HBV)

• Virus: Enveloped, partially double-stranded DNA (Hepadnaviridae)
• Transmission: Blood, sexual contact, perinatal
• Course: Acute or chronic
• Complications: Cirrhosis, liver failure, HCC
• Key points:
  • Chronicity risk highest in neonates
  • Functional cure achievable, not eradication
• Treatment: Tenofovir, entecavir; pegylated interferon (selected cases)
• Prevention: Universal vaccination, perinatal prophylaxis (HBIG + vaccine)

Hepatitis C (HCV)

• Virus: Enveloped RNA (Flaviviridae)
• Transmission: Blood exposure (IV drug use, transfusions pre-1992)
• Course: Frequently chronic
• Complications: Cirrhosis, HCC, extrahepatic manifestations
• Key points:
  • Often asymptomatic for decades
• Treatment: Direct-acting antivirals (DAAs) → cure rates >95%
• Prevention: No vaccine; screening and harm reduction critical

Hepatitis D (HDV)

• Virus: Defective RNA virus
• Transmission: Blood/sexual (requires HBV coinfection)
• Course: Acute or chronic (often severe)
• Key points:
  • Occurs only with HBsAg-positive patients
  • Accelerates liver disease
• Treatment: Pegylated interferon (limited efficacy)
• Prevention: HBV vaccination prevents HDV

Hepatitis E (HEV)

• Virus: Non-enveloped RNA (Hepeviridae)
• Transmission: Fecal–oral (waterborne); zoonotic
• Course: Usually acute and self-limited
• High-risk groups:
  • Pregnant women (high mortality)
  • Immunocompromised (chronic HEV possible)
• Prevention: Sanitation; vaccine available in limited regions only

Pharmacist’s Role & Clinical Pearls

• Promote vaccination (HAV, HBV)
• Ensure appropriate screening (HBV, HCV)
• Optimize antiviral therapy selection, duration, and adherence
• Monitor:
  • Liver enzymes
  • Viral load
  • Drug–drug interactions (especially DAAs)
• Counsel on:
  • Transmission prevention
  • Alcohol avoidance
  • Hepatotoxic medication risk
• Coordinate care for pregnant patients, neonates, and immunocompromised individuals