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chronic hepatitis
Etiology:
1) viral hepatitis
a) hepatitis B (HBV)
b) hepatitis C (HCV))
2) drug-induced chronic hepatitis
3) autoimmune chronic hepatitis
4) hemochromatosis
5) alpha-1 antitrypsin deficiency
Epidemiology:
1) hepatitis B
a) risk is age-dependent
1] 90% for infants
2] 25-50% for children age 1-5 years
3] < 5% for adults
b) higher mortality than chronic hepatitis C [2]
2) hepatitis C -> most common cause of chronic viral hepatitis
3) autoimmune hepatitis
Complications:
1) hepatitis B
a) reactivation of quiescent chronic HBV may occur during immunosuppression with corticosteroids or other immunosuppressive agents
b) risk of hepatocellular carcinoma in patients with HBV- related cirrhosis is 1-3%/year
2) hepatitis C
-> 25-30% progress to cirrhosis over a 20 year period
Laboratory:
1) hepatitis B
-> HBeAg indicates chronic hepatitis & infectivity
2) hepatitis C
a) 85% of patients with anti-HCV have circulating levels of virus by RT-PCR
b) 90% of patients with anti-HCV have evidence of chronic hepatitis on liver biopsy
Management:
1) hepatitis B
a) interferon-alpha terminates viral replication in 40%
b) antiviral nucleotide analogs in clinical trials (1998)
-> lamivudine
2) hepatitis C
a) interferon-alpha
b) ribavirin
2) autoimmune hepatitis
a) glucocorticoids
b) may be worsened by interferon-alpha therapy
Interactions
disease interactions
Related
autoimmune hepatitis
drug/toxin-induced hepatitis
hepatitis B virus (HBV)
hepatitis C virus
Specific
chronic active hepatitis (CAH)
chronic persistent hepatitis (CPH)
chronic viral hepatitis
General
chronic liver disease
hepatitis
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Falade-Nwulia O et al.
Comparative risk of liver-related mortality from chronic
hepatitis B versus chronic hepatitis C virus infection.
Clin Infect Dis 2012 Aug 15; 55:507
PMID: 22523269