A nurse is educating a group of patients about hepatitis infections and their potential to cause chronic liver disease. Which types of hepatitis virus infections can lead to chronic infection? (Select all that apply)

Choice A rationale Hepatitis C virus (HCV) is a single-stranded RNA virus transmitted primarily through blood-to-blood contact. The infection often becomes chronic, meaning the virus persists in the liver for longer than six months. Chronic HCV infection is a major cause of progressive liver disease, cirrhosis, and hepatocellular carcinoma globally. Choice B rationale Hepatitis B virus (HBV) is a DNA virus transmitted through blood, sexual contact, and from mother to child. While many adults clear the virus, a significant percentage of those infected, especially infants and young children, develop a chronic infection, which can lead to cirrhosis and liver cancer over time. Choice C rationale Hepatitis E virus (HEV) is an RNA virus transmitted mainly through the fecal-oral route, usually via contaminated water. HEV typically causes an acute, self-limiting illness and rarely leads to chronic infection, except in specific immunocompromised individuals, such as transplant recipients or HIV patients. Choice D rationale Hepatitis D virus (HDV) is a defective RNA virus that requires the presence of Hepatitis B surface antigen (HBsAg) to replicate, meaning it only infects individuals who also have HBV. Co-infection or super-infection with HDV significantly increases the risk of developing chronic hepatitis, cirrhosis, and rapid progression of liver disease. Choice E rationale Hepatitis A virus (HAV) is an RNA virus transmitted through the fecal-oral route, typically causing a mild to severe acute liver infection. It does not cause chronic liver disease or persistent viremia, as the body typically clears the virus completely within a few weeks to months of infection. .