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Chapter 41: Hepatitis Viruses

INTRODUCTION

Many viruses cause hepatitis. Of these, five medically important viruses are commonly described as “hepatitis viruses” because their main site of infection is the liver. These five are hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV, delta virus), and hepatitis E virus (HEV) (Tables 41–1 and 41–2). Other viruses, such as Epstein–Barr virus (the cause of infectious mononucleosis), cytomegalovirus, and yellow fever virus, infect the liver but also infect other sites in the body and therefore are not exclusively hepatitis viruses. They are discussed elsewhere.

Table 41–1Glossary of Hepatitis Viruses and Their Serologic Markers
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Table 41–1 Glossary of Hepatitis Viruses and Their Serologic Markers
Abbreviation Name and Description
HAV Hepatitis A virus, a picornavirus (nonenveloped RNA virus)
IgM HAV Ab IgM antibody to HAV; best test to detect acute hepatitis A
HBV Hepatitis B virus, a hepadnavirus (enveloped, partially double-stranded DNA virus); also known as Dane particle
HBsAg Antigen found on surface of HBV, also found on noninfectious particles in patient’s blood; positive during acute disease; continued presence indicates carrier state
HBsAb Antibody to HBsAg; provides immunity to hepatitis B
HBcAg Antigen associated with core of HBV
HBcAb Antibody to HBcAg; positive during window phase; IgM HBcAb is an indicator of recent disease
HBeAg A second, different antigenic determinant in the HBV core; important indicator of transmissibility
HBeAb Antibody to e antigen; indicates low transmissibility
Non-A, non-B Hepatitis viruses that are neither HAV nor HBV
HCV Hepatitis C virus, a flavivirus (enveloped RNA virus); one of the non-A, non-B viruses
HDV Hepatitis D virus, small RNA virus with HBsAg envelope; defective virus that replicates only in HBV-infected cells
HEV Hepatitis E virus, a hepevirus (nonenveloped RNA virus); one of the non-A, non-B viruses
Table 41–2Important Properties of Hepatitis Viruses
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Table 41–2 Important Properties of Hepatitis Viruses
Virus Genome Replication Defective DNA Polymerase in Virion HBsAg in Envelope Virus Family
HAV ssRNA No No No Picornavirus
HBV dsDNA1 No Yes Yes Hepadnavirus
HCV ssRNA No No No Flavivirus
HDV ssRNA2 Yes No Yes Deltavirus
HEV ssRNA No No No Calicivirus

ds = double stranded; ss = single stranded.

1Interrupted, circular dsDNA.

2Circular, negative-stranded ssRNA.

Additional information regarding the clinical aspects of infections caused by the viruses in this chapter is provided in Part IX entitled Infectious Diseases beginning on Chapter 70.

Note that these viruses belong to different viral families; some are DNA viruses, whereas others are RNA viruses, and some are enveloped, whereas others are nonenveloped. They are united by their ability to infect hepatocytes because they have proteins on their surface that react with receptors on the surface of hepatocytes.

Note also that they are all noncytotoxic (i.e., they do ...

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