chronic hepatitis
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Etiology
- viral hepatitis
- hepatitis B (HBV)
- hepatitis C (HCV))
- drug-induced chronic hepatitis
- autoimmune chronic hepatitis
- hemochromatosis
- alpha-1 antitrypsin deficiency
Epidemiology
- hepatitis B
- risk is age-dependent
- 90% for infants
- 25-50% for children age 1-5 years
- < 5% for adults
- higher mortality than chronic hepatitis C[2]
- risk is age-dependent
- hepatitis C -> most common cause of chronic viral hepatitis
- autoimmune hepatitis
Laboratory
- hepatitis B
- hepatitis C
- 85% of patients with anti-HCV have circulating levels of virus by RT-PCR
- 90% of patients with anti-HCV have evidence of chronic hepatitis on liver biopsy
Complications
- hepatitis B
- reactivation of quiescent chronic HBV may occur during immunosuppression with corticosteroids or other immunosuppressive agents
- risk of hepatocellular carcinoma in patients with HBV- related cirrhosis is 1-3%/year
- hepatitis C
- 25-30% progress to cirrhosis over a 20 year period
Management
- hepatitis B
- interferon-alpha terminates viral replication in 40%
- antiviral nucleotide analogs in clinical trials (1998)
- hepatitis C
- autoimmune hepatitis
- glucocorticoids
- may be worsened by interferon-alpha therapy
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References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 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: https://www.ncbi.nlm.nih.gov/pubmed/22523269