Which viruses cause viral hepatitis, and what are the major outcomes of infection?

Five hepatotropic viruses (A-E) are the primary causes. Non-hepatotropic systemic viruses (EBV, CMV, HSV, dengue, yellow fever) cause secondary hepatitis. Outcomes range from acute hepatitis to chronic liver disease, cirrhosis, and hepatocellular carcinoma.

Clinical relevance. Knowing which viruses cause chronic disease versus self-limiting illness frames the entire management approach.

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Overview of viral hepatitis

Viral hepatitis is a major global health problem and an important cause of chronic liver disease worldwide.

Causative viruses

• Five hepatotropic viruses: A, B, C, D, E.
• Non-hepatotropic systemic viruses that can cause secondary hepatitis: Epstein-Barr virus, cytomegalovirus, herpes simplex, dengue, yellow fever.

Spectrum of outcomes

• Acute hepatitis (all five can cause this).
• Chronic liver disease, cirrhosis, and hepatocellular carcinoma - caused by the chronic viruses (B, C, D; HEV only in the immunosuppressed).

What drives management

• The specific viral agent.
• Whether infection is acute or chronic.
• Host factors: pregnancy, immune status, and the liver's reserve.

Only the chronic hepatitis viruses cause chronic liver disease and liver cancer; HAV and HEV are essentially self-limiting.