Chronic Consequences of Non-A, Non-B Hepatitis
There has existed a sequential skepticism regarding initially, the existence of, and subsequently, the clinical significance of non-A, non-B hepatitis (NANBH). Skepticism first centered on the question of whether NANBH is a viral disease or merely a transaminitis of nonviral etiology. This initial doubt was dispelled when it was demonstrated that NANBH could be transmitted to the chimpanzee, using acute- and chronic-phase human serum and then serially passaged in the chimpanzee model1, 2; thus, the infectious nature of NANBH was unequivocally established. Accepting the transmissible nature of NANBH, the argument then turned to the clinical significance of the disease, as most cases were anicteric and asymptomatic in the acute phase. Did such mild acute disease merit serious consideration? When it later evolved that approximately 50% of NANBH cases progress to chronic hepatitis and that such progression was just as likely following asymptomatic as following overt icteric hepatitis, it became apparent that such mild cases could not be ignored.3 Skepticism then shifted to another level; i. e., even if NANBH frequently results in chronic hepatitis, as judged by alanine aminotransferase (ALT), is this disease progression associated with any significant histologic outcome? There is a large body of evidence that indicates that approximately 20% of persons with chronic NANBH who are biopsied show histologic evidence of cirrhosis. Data supporting this are detailed in this chapter. Current skepticism revolves around the issue of the clinical importance of NANBH-related cirrhosis. Such cirrhosis appears to be clinically indolent compared with alcohol-induced cirrhosis, and the question has been raised as to whether NANB cirrhosis results in significant morbidity and mortality. This is a more difficult question to address, but certainly liver-related fatality has occurred in a variety of patient groups with chronic NANBH and cirrhosis.
KeywordsChronic Hepatitis Liver Biopsy Chronic Liver Disease Acute Hepatitis Acquire Immune defIciency Syndrome
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