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Chapter 20 : Sequelae of Chronic Viral Hepatitis

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Abstract:

This chapter reviews the natural history of chronic viral hepatitis, focuses on pathogenesis, and outlines the characteristics of the complications and the management. Hepatitis B virus (HBV) is recognized as one of a family of animal viruses called hepadnaviruses and is classified as hepadnavirus type 1. The aims of treatment for chronic HBV (CHB) are to achieve sustained suppression of HBV replication and remission of liver disease. The ultimate goal is to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma (HCC). The current standard of care is combination pegylated interferon (PEG) and weight-based ribavirin (RBV). Viral clearance needs to be achieved prior to the development of cirrhosis to have a marked impact on the development of HCC. There is a single prospective population-based study of the risk of HCC in patients with hepatitis C. In this study of 12,008 men, being anti-HCV positive conferred a 20-fold increased risk of HCC compared to being anti-HCV negative. Liver transplantation remains the most effective treatment because it removes the tumor and eliminates the risk for new tumors, and it prevents liver failure. Another analysis showed that spontaneous reductions over time in HBV DNA levels from 300 to 100,000 copies/ml to <300 copies/ml, after controlling for other risks, eliminated the additional risk of developing HCC, based on the baseline HBV DNA level.

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20

Key Concept Ranking

Viral Hepatitis
0.43926945
Hepatocellular Carcinoma
0.43046013
Highly Active Antiretroviral Therapy
0.4010919
0.43926945
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Figures

Image of Figure 1.
Figure 1.

Outcome of HBV infection based on age at time of infection. Solid line, risk of chronicity; dashed line, percentage presenting with symptoms.

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20
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Image of Figure 2.
Figure 2.

Epidemiology of HCV infection: 170 million (M) people are chronically infected with HCV ( ).

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20
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Image of Figure 3.
Figure 3.

Genotype prevalence of HCV varies according to geographic region ( ).

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20
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References

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Tables

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Table 1.

Responses to approved antiviral therapies among treatment-naive patients with HBeAg-positive CHB

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20
Generic image for table
Table 2.

Responses to approved antiviral therapies among treatment-naive patients with HBeAg-negative CHB

Citation: Sacchi P, Bruno R, Barbaro G, Barbarini G. 2009. Sequelae of Chronic Viral Hepatitis, p 371-388. In Fratamico P, Smith J, Brogden K (ed), Sequelae and Long-Term Consequences of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555815486.ch20

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