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Semin Thromb Hemost 2002; 28(S1): 037-046
DOI: 10.1055/s-2002-30194
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Clinical Aspects of the Different Forms of Viral Hepatitis and Their Treatment

Tobias Goeser
  • Universitäts-Kliniken Köln, Köln, Germany
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Publication Date:
17 May 2002 (online)

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About 30% of patients with chronic hepatitis C go on to develop liver cirrhosis within 20 years. With chronic hepatitis C, interferon-α only leads to elimination of the virus in about 10 to 25% of cases because relapse after the end of treatment is common. There is a growing body of data indicating that the incidence of relapse can be reduced by a longer course of treatment. Alternatively, relapses can be reduced by combination therapy with ribavirin, but we are awaiting the results of studies currently underway. One of the most important predictive factors is the hepatitis C virus (HCV) subtype. For predisposed subtypes, the indication for interferon therapy is overwhelming. Patients with chronic HCV-induced liver failure benefit from liver transplantation in spite of reinfection.

The fecal-oral infections transmitted with hepatitis A virus (HAV) and hepatitis E virus (HEV) normally resolve themselves without any consequences after the acute infection. With HAV infection, a second rise in transaminases is generally seen in the elderly, as is seen with rare cases (<1%) of subacute or fulminant hepatitis. Acute HEV infection occurs in Asia and South America as epidemic hepatitis and is a threat to pregnant women, up to 10% of whom can go on to develop fulminant hepatitis. In Germany, only rare cases of this type of hepatitis are seen, and these occur in vacationers.

On the other hand, the parentally transmitted forms of hepatitis due to hepatitis B virus (HBV), HCV, and hepatitis D virus (HDV) favor a chronic course to a greater or lesser degree, characterized by persistence of the virus and an increase in transaminases over more than 6 months. Worldwide, chronic viral hepatitis is the most common cause of chronic liver diseases, liver cirrhosis, and hepatocellular carcinoma. In adults, chronic forms of viral hepatitis and their consequences are indications for liver transplantation.

The GB-C virus, first described in 1995, is on occasion found in the serum of patients with chronic hepatitis and is virtually identical to hepatitis G virus (HGV). Occasionally, it appears that this virus is responsible for acute posttransfusion hepatitis. However, from the data currently available, there is some doubt as to whether this virus is actually a hepatitis virus in the strictest sense and whether it can lead to chronic hepatitis.[1] [2]

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