Chronic carrier state in viral hepatitis – Identify which listed infections can result in chronicity and persistent carriage.

Introduction:
Chronic hepatitis and carrier states drive cirrhosis and hepatocellular carcinoma risk and inform screening, vaccination, and therapy. This question asks which listed infections can result in chronic carriage.

Given Data / Assumptions:

• HBV can persist, especially when acquired perinatally or in early childhood.
• HCV frequently becomes chronic in adults without spontaneous clearance.
• HDV requires HBV; chronicity can occur in HBV carriers who become superinfected with HDV.

Concept / Approach:
Evaluate each virus for documented chronic infection. HBV and HCV are well-known chronic infections. HDV superinfection in HBsAg carriers can also lead to chronic disease because HBV supplies the envelope, enabling ongoing HDV replication.

Step-by-Step Solution:
Step 1: Confirm HBV: well-established chronic carriage with HBsAg persistence.Step 2: Confirm HCV: high chronicity rates in untreated infections.Step 3: Confirm HDV: dependent on HBV; chronic coinfection/superinfection documented.Step 4: Conclude “All of these.”

Verification / Alternative check:
Clinical guidance emphasizes screening for chronic HBV/HCV, and managing HDV in HBV carriers due to higher severity and progression rates.

Why Other Options Are Wrong:

• Single-virus choices understate the breadth of chronicity among bloodborne hepatitis viruses.
• HAV only: HAV does not become chronic; it is acute and self-limited.

Common Pitfalls:
Assuming dependency (HDV on HBV) precludes chronicity; confusing HAV/HEV (generally non-chronic) with bloodborne agents.

Final Answer:
All of these.