Phys · hepatic
Viral Hepatitis (HAV, HBV, HCV, HDV, HEV)
Also known as hepatitis A · hepatitis B · hepatitis C · hepatitis D · hepatitis E · HBV · HCV · HDV · chronic viral hepatitis · hepatocellular carcinoma · HCC surveillance
Consultant-physician-depth guide to the five hepatotropic viruses — acute versus chronic hepatitis, HBV serology interpretation, the phases of chronic HBV, HCV DAA therapy, HDV and HEV, acute liver failure, and hepatocellular carcinoma surveillance. Structured for FRACP DWE and DCE preparation.
Checked against its sources on 23 Oct 2026
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Red flags
- HBsAg-positive patient about to start immunosuppressive or cytotoxic therapy without anti-HBV prophylaxis — risk of HBV reactivation
- HDV superinfection on chronic HBV — causes severe acute hepatitis
- Hepatitis E in the third trimester of pregnancy — up to 20 to 25 percent of pregnant women can die
- Decompensated cirrhosis in chronic hepatitis B — refer for liver transplantation and start antiviral therapy
Viral Hepatitis (HAV, HBV, HCV, HDV, HEV)
The answer first
Five viruses share the name and the organ, but they split cleanly into two clinical groups. Hepatitis A and E are enteric: faecal-oral spread and, in the immunocompetent, an acute illness that resolves. Hepatitis B, C and D are bloodborne and can persist, and the chronic infections are the ones that end in cirrhosis and liver cancer. Organise every stem around that split. [17] [19] [21] [23] [24]
| Virus | Main route | Chronic infection | Prevention |
|---|---|---|---|
| HAV | Faecal-oral | Does not become chronic | Vaccine |
| HBV | Blood, semen and other body fluids; childbirth, sex, shared injecting equipment | About 90 percent of infected infants; about 95 percent of infected adults recover completely | Vaccine |
| HCV | Percutaneous exposure to infectious blood | More than half of those infected | No vaccine |
| HDV | Blood-borne, transmitted in the same way as HBV; needs HBV to replicate | Occurs only in people living with HBV | Hepatitis B immunisation |
| HEV | Faecal-oral, mainly contaminated drinking water; genotypes 3 and 4 zoonotic via undercooked meat | Rarely, in immunosuppressed people | Vaccine licensed in China |
References26ShowHide
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- [2]Ghany MG, Morgan TR, AASLD-IDSA Hepatitis C Guidance Panel Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Hepatology (Baltimore, Md.), 2020.PMID 31816111
- [3]Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology (Baltimore, Md.), 2023.PMID 37199193
- [4]Pearlman B Hepatitis Delta Infection: A Clinical Review. Seminars in liver disease, 2023.PMID 37473778
- [5]Iqbal H, Mehmood BF, Sohal A, et al. Hepatitis E infection: A review. World journal of virology, 2023.PMID 38187497
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- [7]Marcellin P, Heathcote EJ, Buti M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. The New England journal of medicine, 2008.PMID 19052126
- [8]Lai CL, Shouval D, Lok AS, et al. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. The New England journal of medicine, 2006.PMID 16525138
- [9]Pan CQ, Duan Z, Dai E, et al. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. The New England journal of medicine, 2016.PMID 27305192
- [10]Feld JJ, Jacobson IM, Hézode C, et al. Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection. The New England journal of medicine, 2015.PMID 26571066
- [11]Zeuzem S, Foster GR, Wang S, et al. Glecaprevir-Pibrentasvir for 8 or 12 Weeks in HCV Genotype 1 or 3 Infection. The New England journal of medicine, 2018.PMID 29365309
- [12]Wedemeyer H, Aleman S, Brunetto MR, et al. A Phase 3, Randomized Trial of Bulevirtide in Chronic Hepatitis D. The New England journal of medicine, 2023.PMID 37345876
- [13]Kamar N, Izopet J, Tripon S, et al. Ribavirin for chronic hepatitis E virus infection in transplant recipients. The New England journal of medicine, 2014.PMID 24645943
- [14]O'Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology, 1989.PMID 2490426
- [15]Liu Y, Zhao Y, Gao X, et al. Recognizing skin conditions in patients with cirrhosis: a narrative review. Annals of medicine, 2022.PMID 36308406
- [16]de Bruyn G, Graviss EA A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC medical informatics and decision making, 2001.PMID 11806763
- [17]Centers for Disease Control and Prevention Clinical Overview of Hepatitis A CDC, 2025.Source
- [18]Centers for Disease Control and Prevention Testing and Diagnosis for Hepatitis A CDC, 2024.Source
- [19]Centers for Disease Control and Prevention Clinical Overview of Hepatitis B CDC, 2025.Source
- [20]Centers for Disease Control and Prevention Screening and Testing for Hepatitis B CDC, 2026.Source
- [21]Centers for Disease Control and Prevention Clinical Overview of Hepatitis C CDC, 2025.Source
- [22]Centers for Disease Control and Prevention Testing for Hepatitis C CDC, 2025.Source
- [23]World Health Organization Hepatitis D fact sheet WHO, 2026.Source
- [24]World Health Organization Hepatitis E fact sheet WHO, 2026.Source
- [25]Curry MP, O'Leary JG, Bzowej N, et al. Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis. The New England journal of medicine, 2015.PMID 26569658
- [26]Gane E, Lawitz E, Pugatch D, et al. Glecaprevir and Pibrentasvir in Patients with HCV and Severe Renal Impairment. The New England journal of medicine, 2017.PMID 29020583