Chronic Hepatitis

  • Paul Y. KwoEmail author
  • Nimy John


Chronic viral hepatitis is defined as persistent inflammation of the liver in an identifiable hepatotropic viral (most commonly hepatitis B or C virus) infection persisting for 6 months or longer after acute infection [1]. Patients with chronic viral hepatitis may be asymptomatic or may complain of general fatigue, mild right hypochondoralgia, loss of appetite, nausea, and weakness. Many patients are diagnosed as having chronic viral hepatitis during routine physical with biochemical examination revealing abnormal liver chemistries, typically mild elevation of serum aminotransferases. Occasionally, patients may have flares or exacerbation of necroinflammatory activity in the liver, particularly with hepatitis B [2]. Less common causes of chronic viral hepatitis include hepatitis B/D coinfection and rarely chronic hepatitis E in immunosuppressed patients [3, 4].


Chronic hepatitis B Chronic hepatitis C Chronic hepatitis D Chronic hepatitis Autoimmune hepatitis Fibrosis Cirrhosis 



Autoimmune hepatitis


Alanine aminotransferase


AST-to-platelet ratio index


Direct-acting antiviral agents


Deoxyribonucleic acid


Hepatitis B core antigen


Hepatitis B surface antigen


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


Hepatitis D virus


Human immunodeficiency virus


Ribonucleic acid


Sustained viral response


  1. 1.
    Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22(6):696–9.CrossRefGoogle Scholar
  2. 2.
    Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261–83.CrossRefGoogle Scholar
  3. 3.
    Jacobson IM, Dienstag JL, Werner BG, et al. Epidemiology and clinical impact of hepatitis D virus (delta) infection. Hepatology. 1985;5(2):188–91.CrossRefGoogle Scholar
  4. 4.
    Kamar N, Selves J, Mansuy J-M, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008;358(8):811–7.CrossRefGoogle Scholar
  5. 5.
    Tamaki N, Kurosaki M, Matsuda S, et al. Prospective comparison of real-time tissue elastography and serum fibrosis markers for the estimation of liver fibrosis in chronic hepatitis C patients. Hepatol Res. 2014;44(7):720–7.CrossRefGoogle Scholar
  6. 6.
    Afdhal NH, Bacon BR, Patel K, et al. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clin Gastroenterol Hepatol. 2015;13(4):772–9 e1-3.CrossRefGoogle Scholar
  7. 7.
    Tong MJ, Kowdley KV, Pan C, et al. Improvement in liver histology among Asian patients with chronic hepatitis B after long-term treatment with entecavir. Liver Int. 2013;33(4):650–1.CrossRefGoogle Scholar
  8. 8.
    Kuo YH, Lu SN, Chen CH, et al. The changes of liver stiffness and its associated factors for chronic hepatitis B patients with entecavir therapy. PLoS One. 2014;9(3):e93160.CrossRefGoogle Scholar
  9. 9.
    Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral direct-acting agent therapy for hepatitis C virus infection: a systematic review. Ann Intern Med. 2017;166(9):637–48.CrossRefGoogle Scholar
  10. 10.
    Whitford K, Liu B, Micallef J, et al. Long-term impact of infant immunization on hepatitis B prevalence: a systematic review and meta-analysis. Bull World Health Organ. 2018;96(7):484.CrossRefGoogle Scholar
  11. 11.
    Chisari FV, Ferrari C. Hepatitis B virus immunopathology. Semin Immunopathol. 1995;17(2-3):261–81.Google Scholar
  12. 12.
    Sarin S, Kumar M, Lau G, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1–98.CrossRefGoogle Scholar
  13. 13.
    Liver EAFTSOT. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98.CrossRefGoogle Scholar
  14. 14.
    Davies SE, Portmann BC, O’Grady JG, et al. Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis. Hepatology. 1991;13(1):150–7.CrossRefGoogle Scholar
  15. 15.
    Blach S, Zeuzem S, Manns M, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–76.CrossRefGoogle Scholar
  16. 16.
    Gower E, Estes C, Blach S, et al. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61(1):S45–57.CrossRefGoogle Scholar
  17. 17.
    Freni MA, Artuso D, Gerken G, et al. Focal lymphocytic aggregates in chronic hepatitis C: occurrence, immunohistochemical characterization, and relation to markers of autoimmunity. Hepatology. 1995;22(2):389–94.CrossRefGoogle Scholar
  18. 18.
    Kaji K, Nakanuma Y, Sasaki M, et al. Hepatitic bile duct injuries in chronic hepatitis C: histopathologic and immunohistochemical studies. Mod Pathol. 1994;7(9):937–45.PubMedGoogle Scholar
  19. 19.
    Bochud PY, Cai T, Overbeck K, et al. Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis C. J Hepatol. 2009;51(4):655–66.CrossRefGoogle Scholar
  20. 20.
    Panel AIHG, Chung RT, Davis GL, et al. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology. 2015;62(3):932–54.CrossRefGoogle Scholar
  21. 21.
    Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C. J Hepatol. 2018.Google Scholar
  22. 22.
    Clifford BD, Donahue D, Smith L, et al. High prevalence of serological markers of autoimmunity in patients with chronic hepatitis C. Hepatology. 1995;21(3):613–9.PubMedGoogle Scholar
  23. 23.
    Kobayashi M, Tanaka E, Sodeyama T, et al. The natural course of chronic hepatitis C: a comparison between patients with genotypes 1 and 2 hepatitis C viruses. Hepatology. 1996;23(4):695–9.CrossRefGoogle Scholar
  24. 24.
    Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349:825–32.CrossRefGoogle Scholar
  25. 25.
    Davis GL, Albright JE, Cook SF, et al. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9(4):331–8.CrossRefGoogle Scholar
  26. 26.
    Kamar N, Dalton HR, Abravanel F, et al. Hepatitis E virus infection. Clin Microbiol Rev. 2014;27(1):116–38.CrossRefGoogle Scholar
  27. 27.
    Sempoux C, Jibara G, Ward SC, et al. Intrahepatic cholangiocarcinoma: new insights in pathology. In: Seminars in liver disease. 20Thieme Medical; 2011.Google Scholar
  28. 28.
    Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005;5(9):558–67.CrossRefGoogle Scholar
  29. 29.
    Di Martino V, Rufat P, Boyer N, et al. The influence of human immunodeficiency virus coinfection on chronic hepatitis C in injection drug users: a long-term retrospective cohort study. Hepatology. 2001;34(6):1193–9.CrossRefGoogle Scholar
  30. 30.
    Drebber U, Kasper HU, Krupacz J, et al. The role of Epsteincohort studyction drug users: a longers: a. J Hepatol. 2006;44(5):879–85.CrossRefGoogle Scholar
  31. 31.
    Tanaka S, Toh Y, Minagawa H, et al. Reactivation of cytomegalovirus in patients with cirrhosis: analysis of 122 cases. Hepatology. 1992;16(6):1409–14.CrossRefGoogle Scholar
  32. 32.
    Larrey D. Bacterial hepatitis. Gastroenterol Clin Biol. 2003;27(5 Suppl):B27–31.PubMedGoogle Scholar
  33. 33.
    Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int. 2017;37:81–4.CrossRefGoogle Scholar
  34. 34.
    Vierling JM. Autoimmune hepatitis and overlap syndromes: diagnosis and management. Clin Gastroenterol Hepatol. 2015;13(12):2088–108.CrossRefGoogle Scholar
  35. 35.
    Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981;1(5):431–5.CrossRefGoogle Scholar
  36. 36.
    Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol. 1991;13(3):372–4.CrossRefGoogle Scholar
  37. 37.
    Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol. 1995;19(12):1409–17.CrossRefGoogle Scholar
  38. 38.
    Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24(2):289–93.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.CaliforniaUSA

Personalised recommendations