Chronic hepatitis G

As a monoinfection, chronic hepatitis G is rare. When examining patients with chronic hepatitis "neither A, nor B, nor D, conducted in Europe. USA and Japan, the detectability of their hepatitis G virus ranged from 3 to 15%, which is significantly higher than the detection of HGV in blood donors, but similar to the frequency of detection in control groups (with non-viral liver diseases). This statistical fact indicates a possible, but not absolute, involvement of the hepatitis G virus in the formation of chronic hepatitis

In the world literature, in most cases, a combination of chronic hepatitis G with widespread chronic hepatitis C and B is reported.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11],

Pathomorphology

Pathomorphological examination was mainly performed on liver tissue samples obtained with biopsy of HGV-positive patients with chronic hepatitis C and undergone liver transplantation with HGV-positive patients. Of great interest are the data of M.P. Rralet et al. (1997), who examined 17 biopsies from patients with GBV-C (HGV) and HCV infection. Cirrhosis was found in 4 (24%); hepatitis of small, moderate and high activity - in 3 (18%), 11 (64%) and 3 (18%), respectively; periportal step necroses are equally expressed in 4 (24%), 10 (58%) and 3 (18%). Intralobular necrosis of hepatocytes was found in 35% of biopsy specimens, balloon hepatocytes - in 18 multinucleated - in 6%. Portal inflammatory infiltration was insignificant, moderate or severe in 4 (24%), 12 (70%) and 1 (5%) biopsies, respectively, and was uniformly distributed in portal spaces; lymphoid aggregates or follicles were detected in 64%, creasoma - in 82, lymphocytic cholangitis - in 12, cholangiolytic proliferation - in 59% of patients. Accumulation of hemosiderin in hepatocytes (usually insignificant) and / or in sinusoidal cells was found in 35% of patients. Nevertheless, pathological changes in liver tissue with isolated HCV infection and joint HCV / HGV infection were almost the same, which casts doubt on the role of HGV in the formation of the tissue hepatic pathology presented above. F. Negro et al. (1997) conducted liver biopsy in 18 HGV-positive patients who had undergone liver transplantation in the past. In 9 of them, histological changes were associated with rejection of transplant (2), acute cholangitis (1), hepatitis C (1) and B (1), steatosis (2). In the other 9 patients, the histological changes likely associated with HGV infection were the development of lobular (4) or portal (1) inflammation, vacuolation of the biliary epithelium (4), marked lymphocytic infiltration of portal tracts. G. Cathomas et af (1997), observing groups of patients with HGV infection, chronic hepatitis C and isolated chronic hepatitis C, found in HCV / HGV infection in the hepatic tissue manifestations of chronic hepatitis of minimal or moderate activity in 61.6 and 23, 1% of cases respectively, as well as the phenomenon of progressive fibrosis in 15.4% of cases, with histological changes in HCV / HGV and only HCV being insignificant.

According to domestic authors, patients with chronic hepatitis G in the liver showed moderate or minimal inflammatory changes in the form of portal and lobular hepatitis. The index of histological activity (IGA) ranged from 2 to 5 points.

Symptoms of chronic hepatitis G

There are few descriptions of the picture of chronic hepatitis G in adults and children. It is reported that men are predominant among CHG patients. The majority (about 70%) had risk factors for infection with hepatitis viruses - surgical interventions, blood transfusion, intravenous drug use, donation, etc.

In adult patients with CGG as a monoinfection, asthenic syndrome is observed, manifested by weakness, rapid fatigue, irritability. Patients also complain of pain in the right hypochondrium, a feeling of heaviness in this area; Dyspeptic phenomena are noted (nausea, worsening of appetite, disturbance of stool).

The increase in liver size is not observed in all patients with chronic hepatitis G, rarely the enlarged spleen. Jaundice sclera is detected in 30-40% of patients.

Hepatic signs are noted in 10-13% of cases.

More than half of patients with HGG have biochemical changes. Hyperfermentemia was observed, as a rule, minimal or moderate (ALT and ACT exceeded the norm 2-5 times). In a few cases, a cholestatic variant of the disease developed.

With mixed HCG with CHC and / or CHB, all clinicians have a slight effect of hepatitis G virus on the functional state of the liver, which is manifested in the absence of "enrichment" of clinical manifestations and enhancement of the cytolytic syndrome, when compared with clinico-biochemical parameters only in CHC or CHB .

The course and outcome of chronic hepatitis G

Chronic hepatitis G can occur for a long time - up to 9-12 years. However, under the influence of interferon therapy or spontaneously in some patients, HG viremia stops and a remission occurs. Also, when combined with CHC and / or CHB, the HG virus can disappear from serum and subsequently not become evident.

Children have a similar pattern. Chronic hepatitis G can persist for a long time, but sanation from HCV virus may occur, including with mixed infection with HCV.

The literature on the outcome of chronic hepatitis G in cirrhosis is not available.

Treatment of chronic hepatitis G

Recommendations for the treatment of chronic hepatitis G are based on data obtained in the treatment of patients with mixed viral hepatitis. It is shown that under the influence of interferon therapy, the concentration of HGV decreases simultaneously with the decrease of HBV and HCV titers, while the presence of HGV does not worsen the process in CHB and CHC and does not affect the dynamics of hepatitis B and C virus titers.