Table 21.1Hepatitis Viruses

Hepatitis virusHAVHBVHCVHDVHEV
Structure
FamilyPicornaviridaeHepadnaviridaeFlaviviridaeDeltaviridaeCalciviridae/togavirus
Size (nm)284238–503632
GenomeSingle-stranded RNA (+) 7.5 kbDouble-stranded DNA 3.2 kbSingle-stranded RNA (+) 9.4 kbSingle-stranded RNA (+) 1.7 kbSingle-stranded RNA (+) 7.8 kb
Envelope proteinsNoneLarge, middle, major HBsAgE1, D2Yes (major HBsAg from HBV)None
Capsid proteinsVP1, VP2, VP3HBcAgNS2, NS3, NS4Small and large HDAg (p24, 27)2
Genomic integrationNoYesNoNoNo
Genotypes456 (15 subtypes)33
Serotypes11??1
Clinical
Incubation period30 days75 days50 days75 days40 days
TransmissionFecal-oralParenteralParenteralParenteralFecal-oral
Tissues infectedLiverLiver, blood mononuclear cellsLiver, blood mononuclear cellsLiverLiver
Virus persistenceNoYesYesYesNo
Association with HCCNoYesYesNoNo
Acute hepatitisYesYesYesYesYes
Chronic hepatitisNoYesYesYesNo
Progression to chronic hepatitis after acute infection0%1–10% adults, 90% neonates50–80%2–5% co-infection, 70–90% superinfection0%
Diagnosis
AcuteIgM anti-HAVIgM anti-HBc, HBsAg, HBeAg, HBV DNAHCV RNA, anti-HCVIgG anti-HDAg (> 1:1000), HDV RNAHEV RNAIgM anti-HEV, HEV RNA
ChronicNAHBsAg, HBeAg, HBV DNAHCV RNA, anti-HCVIgG anti-HDAg (> 1:1000)NA
Past infectionIgG anti-HAV*Anti-HBsa, anti-HBc, anti-HBeAnti-HCVIgG anti-HDAg (< 1:1000)IgG anti-HEV
Treatment
Acute
ChronicInterferon-alpha, lamivudineInterferon-alphaInterferon-alpha
End stageTransplantTransplant + HBIgTransplantTransplantTransplant
Prevention
Pre-exposureHAV vaccineHBV vaccineHBV vaccineSanitation of water supply
Post-exposureHAV vaccine + IgHBV vaccine + HBIg

HCC = hepatocellular carcinoma.

*

Also post vaccination.

From: Chapter 21, Hepatitis Viruses

Cover of Holland-Frei Cancer Medicine
Holland-Frei Cancer Medicine. 5th edition.
Bast RC Jr, Kufe DW, Pollock RE, et al., editors.
Hamilton (ON): BC Decker; 2000.
© 2000, BC Decker Inc.

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