Chronic Hepatitis

Chronic Hepatitis

Chronic hepatitis (CH) is a condition characterized by long-term inflammation of the liver, leading to chronic liver damage. In Vietnam, the primary cause of CH is viral, particularly hepatitis B virus (HBV). In contrast, in the United States, non-alcoholic fatty liver disease (NASH) and alcohol are more common culprits.

Clinical Manifestations:

• Gastrointestinal symptoms: Loss of appetite, fatigue, right upper quadrant pain.

• Jaundice: Yellowing of the skin, dark urine.

Subclinical Manifestations:

• Liver function: ALT, AST elevated 2-10 times above normal.

• Other tests: INR, bilirubin elevated, albumin decreased, NH3 increased.

Diagnosis of Chronic Hepatitis B:

• Lab tests: HBsAg (+) along with HBV-DNA (+) for more than 6 months and anti-HBc IgM (-).

Stage and Severity Assessment:

• Liver biopsy: Determines the degree of liver fibrosis.

• Stage F3: Bridging fibrosis.

• Severity: Based on the extent of liver fibrosis and liver function.

Indications for Treatment of CH:

• Based on 3 criteria: ALT, liver fibrosis, HBV-DNA.

• Exceptions: Treatment is not required when HBV-DNA (-) and no liver damage is present.

Indications for Treatment in Patients with Cirrhosis:

• HBV-DNA: Treatment is indicated for those with cirrhosis stage F4.

Indications for Treatment in Patients without Cirrhosis:

• Active virus: HBV-DNA (+) accompanied by liver damage.

• Special cases:

Stopping Treatment:

• Following treatment regimen: Regular monitoring and assessments are conducted to determine if treatment can be stopped.

Treatment Groups for CH:

• TDF Group: Tenofovir disoproxil fumarate

• TAF Group: Tenofovir alafenamide

• ETV Group: Entecavir

• PEG Group: Pegylated interferon

Duration of PEG Treatment: 48 weeks.

Hepatitis D Treatment:

• PEG: 48 weeks.

Alcohol-induced Hepatitis:

• AST/ALT ratio: AST > ALT.

Fatty Liver Disease:

• AST/ALT ratio: ALT > AST.

• Ferritin: Elevated in 50% of patients.