There is no specific treatment for hepatitis D. Because the infection is linked to hepatitis B, prevention of hepatitis D should begin with prevention of hepatitis B through vaccination.The hepatitis E virus is an enveloped, single-stranded RNA virus. It is transmitted bythe fecal–oral route and causes manifestations of acute hepatitis that are similar to hepatitis A. It does not cause chronic hepatitis or the carrier state.3A distinguishing feature of HEV infection is the high mortality rate (approximately 20%) among pregnant women, owing to the development of fulminant hepatitis. The infection occurs primarily in developing coutries of the world. The only reported cases in the United States have been in persons who have recently been in an endemic area.Chronic Viral Hepatitis38
Chronic hepatitis is defined as a chronic inflammatory reaction of the liver, or positive viral serologies of more than 6 months’ duration. Chronic viral hepatitis is the principalcause of chronic liver disease, cirrhosis, and hepatocellular cancer in the world and now ranks as the chief reason for liver transplantation in adults.17Of the hepatotropic viruses, only three are known to cause chronic hepatitis—HBV/ HDV and HCV. In both HBV and HCV, fibrosis and clinical manifestations of chronic disease result from host immune responses directed against viral antigens. In response to these viral antigens, the host immune system directs cytoxic T lymphocytes and cytokines to inhibit viral replication (Chapter 15), the effects of which induce inflammation and liver injury.There are several treatment options for chronic viral hepatitis. Drugs used in the treatment of chronic hepatitis B include the recombinant human interferon-2α and peginterferon or nucleotide analog antiretroviral agent. Persons with active viral replication may be treated with recombinant human interferon-2α and peginterferon. Peginterferons were developed by adding a polyethylene glycol (PEG) moiety to an interferon molecule (PEG-IFN), resulting in a prolonged serum half-life and the ability to administer the compound once weekly. Nucleoside and nucleotide analogs (e.g., entecavir, tenofovir) have shown good efficacy and better tolerance and may be used instead of interferon for treatment of chronic HBV infection.18The current treatment for persons with chronic hepatitis C is a combination of peginterferon (alfa-2b or alfa-2a) plus ribavirin (a nucleoside analog), plus sofosbuvir (a polymerase inhibitor) or sofosbuvir plus ribavirin.19Treatment for HCV is 70% to 80% effective, but is costly and has side effects. These side effects range from flulike symptoms, which are almost universal, to more serious and less common side effects, such as psychiatric symptoms (depression, anxiety), thyroid dysfunction, and bone marrow suppression. Although most persons with HCV infection are candidates for treatment, many have other healthproblems that are contraindications to therapy.