Causes of Chronic Hepatitis

Hepatitis B and C are the leading causes of chronic hepatitis globally, accounting for over 75% of cases.

• Hepatitis B is more common in China, sub-Saharan Africa, among male homosexuals, and IV drug users.

• Hepatitis C generally causes mild symptoms, with fatigue being the most common. However, cirrhosis may develop after 10 or more years, often without warning. Compared to hepatitis B, hepatitis C leads to cirrhosis more frequently, though it less commonly causes primary liver cancer.

Autoimmune Hepatitis varies in severity but frequently leads to cirrhosis, sometimes early in the disease. It primarily affects young women but also occurs in men and older women. About 25% of chronic hepatitis cases result from immune system attacks on liver tissue, likely triggered by unknown factors. The disease is typically progressive.

Hepatitis A and E do not cause chronic hepatitis.
Hepatitis D requires co-infection with hepatitis B to replicate and worsens the progression of liver disease. IV drug users are at high risk.
 

Other Causes

• Herpesviruses (e.g., cold sores, chickenpox, mononucleosis) can cause acute hepatitis, particularly in immunocompromised individuals, but rarely lead to chronic disease.

• Unidentified viruses may contribute to some cases.
   

Drug-Induced Hepatitis
 

Some medications can cause chronic hepatitis, including:

• Isoniazid (TB)

• Methyldopa (hypertension)

• Nitrofurantoin (UTIs)

• Phenytoin (seizures)
   

These typically require long-term use. If recognized early and the drug is stopped, liver damage is often reversible.
 

Inherited Disorders

Metabolic conditions like Wilson’s disease, alpha-1-antitrypsin deficiency, and tyrosinemia can mimic chronic hepatitis but have distinct diagnostic features.
 

Signs and Symptoms

Fatigue is the most common and often disabling symptom. Other symptoms may include:

• Upper abdominal discomfort

• Loss of appetite

• Joint pain
   

In advanced cases:

• Jaundice

• Ascites (fluid accumulation)

• Confusion or coma (hepatic encephalopathy)
   

Chronic hepatitis may be classified as:

• Chronic Persistent Hepatitis (CPH): Mild and limited

• Chronic Active Hepatitis (CAH): More severe, with active liver cell destruction
   

Treatment

Interferon therapy is used for hepatitis B and C. It eliminates the virus in about 25–30% of cases and helps prevent cirrhosis. However, 50% of responders relapse after treatment ends. Side effects can include flu-like symptoms, depression, hair loss, and nausea.

• Treatment: Injection three times a week for six months

• Monitoring: Regular blood tests and liver biopsies before and after treatment
   

Interferon is less effective in:

• Those with substance abuse issues

• People with mild disease or minor lab abnormalities

• Individuals with AIDS or other immune suppression

• Hepatitis B carriers infected at birth

• Patients with major organ disease

• Couples trying to conceive
   

Prognosis

• Only a small percentage of patients with chronic hepatitis B progress to cirrhosis.

• Hepatitis C has a higher risk of cirrhosis but less frequent liver cancer.

• Cirrhosis is the major turning point toward life-threatening complications.
   

In the East, men over 50 with hepatitis B have a 15% risk of liver cancer—less common in the West.

Over half of patients live 15 years or more after diagnosis, and outcomes continue to improve.
 

Autoimmune Hepatitis Treatment

Steroids are the mainstay, often lifelong, but may not prevent cirrhosis. Liver inflammation pattern and extent inform prognosis.
 

Liver Transplantation

A viable option for end-stage liver disease due to chronic hepatitis.

• Hepatitis B may recur in the new liver

• Hepatitis C and autoimmune hepatitis typically do not recur
   

Prevention

Hepatitis B vaccination is key:

• All pregnant women should be tested

• Newborns should be vaccinated (3-dose series)

• Carriers should be aware of transmission risks to partners and infants
   

Supportive Care

• Eat a balanced diet; extreme diets lack evidence and may be harmful

• Avoid excess salt to reduce fluid retention

• Limit non-essential medications due to impaired liver detoxification

• Avoid sedatives and tranquilizers

• Physical activity may help reduce fatigue
   

The Road Ahead

Research continues into viral control, immune modulation, and relapse management. With vaccination, new therapies, and improved transplantation outcomes, the outlook for patients with chronic hepatitis is steadily improving. The ultimate goal: prevention and eradication.
 

American Liver Foundation
1425 Pompton Avenue, Cedar Grove, NJ 07009
Phone: 1-800-223-0179