Liver and intrahepatic bile ducts-nontumor
Viral hepatitis
Chronic viral hepatitis

Author: Abul Ala Syed Rifat Mannan, M.D. (see Authors page)
Editor: Songyang Yuan, M.D., Ph.D.

Revised: 17 December 2015, last major update December 2015

Copyright: (c) 2003-2015,, Inc.

PubMed Search: Chronic viral hepatitis [title]
Cite this page: Chronic viral hepatitis. website. Accessed October 21st, 2016.
Definition / General
  • Chronic viral hepatitis is a major global health problem, affecting more than 600 million people worldwide
Essential Features
  • Chronic viral hepatitis is defined as persistence of viral antigen or RNA in the serum for more than 6 months after the onset of acute infection
  • In infected individuals, viruses induce a chronic inflammatory process
  • Longstanding repetition of the inflammation and healing process may lead to liver fibrosis, cirrhosis and eventually hepatocellular carcinoma
  • Hepatitis B virus (HBV)
    • A small DNA virus consists of a central core composed of DNA and hepatitis B core antigen (HBcAg) and a shell of hepatitis B surface antigen (HBsAg)
    • 240 million people are chronically infected with HBV worldwide
    • Chronic HBV infection is endemic in Southeast Asia, China and sub-Saharan Africa
    • HBV usually causes an acute hepatitis, but chronic hepatitis develops in 10% of patients
    • 15 - 40% of infected patients may develop serious liver disease, resulting in 1.2 million deaths per year
  • Hepatitis C virus (HCV)
    • HCV is a positive sense, single stranded 9600 kb RNA virus
    • HCV affects more than 170 million people worldwide
    • Central and east Asia, North Africa and the Middle East have the highest prevalence
    • 80 - 85% of patients with acute hepatitis C cannot clear the virus and progress to chronic infection
    • The percentage of transition to chronic infection is higher for patients co-infected with HIV, and is lower for women and children
    • 20% to 30% of patients develop cirrhosis in two decades, accounting for 500,000 deaths per year
  • Hepatitis D virus (HDV)
    • A defective RNA virus which requires the obligatory help of HBV for transmission and packaging
    • HDV infection is higher in areas where HBV is endemic
    • HDV superinfection in an HBV carrier usually results in chronic HDV infection, occurring in over 90% of cases
    • Compared with chronic HBV infection, chronic HBV/HDV coinfection is associated with a higher risk of cirrhosis, occurring in 70% of cases
    • In about 15% of patients, cirrhosis develops within 1 to 2 years from the onset of acute HDV infection
  • Three viruses are known to cause chronic hepatitis:
    • Hepatitis B virus (HBV)
    • Hepatitis C virus (HCV)
    • Hepatitis D virus (HDV)
  • Other viruses are uncommon to cause chronic hepatitis
Clinical Features
  • Clinical manifestations vary widely, reflecting the interaction between viral pathogens and patient antiviral immune responses
  • Some patients remain asymptomatic for many years, while others may rapidly progress to cirrhosis and finally hepatocellular carcinoma
  • Characteristic symptoms include malaise, anorexia, fatigue, low grade fever and right upper quadrant abdominal pain
  • Jaundice is often absent
  • Aminotransferase levels may be within the reference range or may reach 300 U/L
  • Extrahepatic manifestations can occur in multiple organs including kidneys, eyes, joints, skin
  • HBV infection may cause skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa
  • HCV infection has been associated with cryoglobulinemia, glomerulonephritis, idiopathic thrombocytopenic purpura, Sjogren syndrome
Micro Images

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Portal inflammation in chronic hepatitis

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Interface hepatitis

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Lobular inflammation

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Fibrosis and cirrhosis

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Ground glass hepatocytes

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Chronic hepatitis C