Advances continue in the field of viral hepatitis. The identification of receptors for hepatitis A virus will lead to a better understanding of its pathogenesis and perhaps to the development of new diagnostic and therapeutic strategies. Nevertheless, prevention of hepatitis A on a worldwide basis will come with the availability of inactivated vaccines. Implementation of universal vaccination for hepatitis B virus will reduce the number of acute and chronic cases and the risk for developing hepatocellular carcinoma. For those with chronic hepatitis B virus infection, interferon-α treatment has proven effective. Immune selection, a consequence of vaccine programs and antiviral therapy, has probably contributed to the emergence of mutant forms of hepatitis B virus. Hepatitis D virus, previously considered a defective virus requiring coinfection with hepatitis B virus to thrive, was shown to replicate in immunosuppressed patients undergoing organ transplantation without clinical evidence of infection. Hepatitis E virus has now been reported in the United States, primarily in tourists or immigrants coming from endemic areas. Parasitic infections remain an important cause of morbidity in tropical and subtropical regions. Finally, new bacteria continue to be identified in the pathogenesis of liver disease, especially among patients with acquired immunodeficiency syndrome.
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