An update on hepatitis B, D, and E viruses.

Although newer and more effective treatments are now available for hepatitis C virus (HCV) infection, non-HCV viral hepatitis remains an important cause of liver disease, especially among HIV-infected individuals. Hepatitis B virus (HBV) is the leading cause of cirrhosis worldwide, and approximately one-quarter of patients with cirrhosis develop decompensated liver disease within 5 years. Initial treatment for chronic HBV infection includes peginterferon alfa, entecavir, and tenofovir. Approximately 15 million of the estimated 350 million individuals with chronic HBV infection have evidence of exposure to hepatitis D (delta) virus (HDV), which requires hepatitis B surface antigen for transmission and packaging. HBV/HDV coinfection is associated with more severe acute hepatitis and higher mortality than acute HBV monoinfection. Chronic coinfection is associated with a higher risk of cirrhosis and decompensated liver disease. The mainstay of treatment for HDV infection is peginterferon alfa for at least 48 weeks. Cases of hepatitis E virus (HEV) infection in HIV-infected persons have been reported. HEV infection can become chronic in immunosuppressed patients, and chronic infection is associated with rapid development of cirrhosis. There are no established guidelines for treating HEV infection in HIV-infected persons. This article summarizes a presentation by Jennifer Price, MD, at the IAS-USA continuing education program held in San Francisco, California, in June 2013.