Chronic Hepatitis Etiology

by Jau-Shin WU, M.D.

†HBV, HCV, HDV, Drug, Toxin, Autoimmune, Cryptogenic

†Prevalence: different depends on geographical region, ethnic back ground, high risk behavior.

†Etiological viruses can be identified by serological tests.

†1. HBV:

†Serum tests for HBsAg, HBeAg, HBV-DNA and histological verification of HBcAg.

†Serum HBsAg, HBeAg, HBV-DNA (+)¡Gpersisting replication of viruses .

†Serum HBeAg, HBV-DNA (-) with anti-HBe (+)¡Gusually present with milder clinical symptoms with less viruses — usually seen in asymptomatic carrier.

†HBV variant (precore or HBeAg negative mutant) — Failure to produce HBeAg, but with persistent anti-HBe and HBV-DNA — persistent
progression of hepatic inflammation.
†2. HCV:

†Serum anti-HCV and HCV-RNA (+) — histological activity is related to degree of viral replication.

†In some cases, there are production of autoantibodies such as: ANA, anti-LKM (anti-liver and kidney microsomes).

†3. HDV:

†Serum anti-HDV and HDV-RNA (+)

†Serum HBsAg: usually (+)

†4. Autoimmune:

†Patients losing immunological tolerance of liver itself.

†Various factors as: Genvironment, varied contageous agents trigger the disease.

†Female predominance.

†Serum hypergammaglobulinemia: more predominant.

†HLA Type: predominantly B8, DR3, DR4

†Frequently associated with autoimmune diseases such as: thyroiditis, ulcerative colitis, Sjogren’s syndrome.

†With chracteristic serum autoimmune antibodies such as: ANA, Anti-LKM antibody, anti-smooth muscle antobody, anti-soluble liver antigen antibody,anti-liver-pancreas antigen antibody, anti-asialoglycoprotein receptor antibody, anti-heptocyte plasma membrane antigen antibody.

†Absence of serum markers of HBV, HCV and HDV infections and anti-mitochrondrial antibody.

†Well respond to corticosteroid and/or immunosuppressive therapy.

†Subgroups of autoimmune hepatitis:

†Autoimmune hepatitis type 1: high titers of ANA or SMA.

†Autoimmune hepatitis type 2: presence of anti-LKM-1 directed against cytochrome P-450 IID6.

†Autoimmune hepatitis type 3: presence of soluble liver antigen antobodies in the absence of ANA or anti-LKM.

†5. Drug-induced chronic hepatitis:

†drugs as a cause of liver injury.

†6. Cryptogenic chronic hepatitis:

†Without evidence of viral, drug-induced or autoimmune induced liver injuries.

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