This chapter explains the disease of hepatitis, with separate sections on the five known hepatitis viruses, A–E. The etiology, pathogenesis, epidemiology and clinical manifestations of infection by each virus are described. Tests are included for diagnosis, discriminating between acute and chronic infections, and monitoring response to vaccination, and typical assay technology is described. The tests reviewed are: anti-HAV IgM, anti-HAV IgG, HAV RNA, HBsAg, HBeAg, anti-HBs, anti-HBc, anti-HBc IgM, anti-HBe, anti-HCV, HCV RNA, HDAg, HDV RNA, anti-HD IgM, anti-HD IgG, HEV RNA, anti-HE IgM and anti-HE IgG.

Ravi Kaul is the Business Unit R&D Manager at Bio-Rad Laboratories based in Benicia, California. His current responsibilities include the development of BioPlex based serology assays for infectious diseases and autoimmune disorders. Ravi employs multiplexed bead technology for use in diagnostic products. He has published more than 30 papers in peer-reviewed journals. Prior to joining Bio-Rad Laboratories, Ravi was Associate Adjunct Professor in Pediatric Infectious Diseases at the University of California, Davis.

Liver, hepatitis, infectious hepatitis, Australia Antigen, Dane particle, hepatocarcinoma, jaundice, liver disease, hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, vaccination, anti-HAV IgM, anti-HAV IgG, HAV RNA, HBsAg, HBeAg, anti-HBs, anti-HBc, anti-HBc IgM, anti-HBe, anti-HCV, HCV RNA, HDAg, HDV RNA, anti-HD IgM, anti-HD IgG, HEV RNA, anti-HE IgM, anti-HE IgG, recombinant immunoblot assay.

The introduction of Sovaldi® (Sofosbuvir) from Gilead has caused controversy. It is an effective antiviral treatment for Hepatitis C, curing most infected individuals when used as part of a combination therapy. This is a huge clinical breakthrough but the treatment regime costs $84,000 in the US at the time of writing. Sofosbuvir is a prodrug that forms a substituted uridine triphosphate, which inhibits the RNA polymerase that the hepatitis C virus uses to replicate its RNA, acting as a defective substrate. It was discovered at Pharmasset, subsequently acquired by Gilead.

Testing algorithms for hepatitis are available at www.arupconsult.com/algorithms/or.html.