Hepatitis B and C

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infect hepatocytes and can produce acute or persistent liver inflammation. The liver injury is driven largely by the host immune response to infected cells. When inflammation continues, scar tissue accumulates, liver architecture becomes distorted, and the patient may progress to cirrhosis, portal hypertension, liver failure, or hepatocellular carcinoma. The two infections are related clinically but are not interchangeable. HBV can be prevented with vaccination and may resolve after an acute infection; persistent hepatitis B surface antigen (HBsAg) indicates chronic infection. HCV has no vaccine, and antibody testing alone cannot show whether the virus is still present. Transmission occurs primarily through infected blood and, for HBV, through sexual and perinatal exposure as well. Sharing needles or other injection equipment, needlestick exposure, unsterile tattooing or piercing, and sexual exposure can transmit either virus. Casual contact such as hugging, sharing a meal, or sitting beside someone does not require isolation precautions. For an RPN, the clinical question is not simply “Does this patient look jaundiced?” The more useful question is whether the liver is...