Chronic viral hepatitis

Liver & intrahepatic bile ducts

Viral hepatitis

Authors: Rifat Mannan, M.D., Songyang Yuan, M.D., Ph.D.

Topic Completed: 1 December 2015

Minor changes: 28 July 2020

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PubMed Search: Chronic viral hepatitis[TI] liver[TI] full text[sb]

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Table of Contents

Cite this page: Mannan A.A.S.R. Chronic viral hepatitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverchronicviralhep.html. Accessed May 17th, 2021.

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

Epidemiology

Hepatitis B virus (HBV)
- 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
- Percentage of transition to chronic infection is higher for patients coinfected with HIV and is lower for women and children
- 20 - 30% of patients develop cirrhosis in two decades, accounting for 500,000 deaths per year
Hepatitis D virus (HDV)
- 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

Etiology

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, Sjögren syndrome

Microscopic (histologic) images

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