1. Viral Hepatitis

2. Causes of Acute Hepatitis

3. Causes of Chronic Hepatitis

4. Hepatitis A

6. Global Prevalence of Hepatitis A Infection
HAV Prevalence
High
Intermediate
Low
Very Low
Global Prevalence of Hepatitis A Infection 16 6

7. Hepatitis B

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Symptoms, or Lack of, in Chronic HCV Infection
Symptomatic 37%
100
Cirrhosis 7% 80 80 60
Patients (%) 40 20
Fatigue
56% Asymptomatic 14 14

15. 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.

16. 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