Chronic hepatitis G

Chronic hepatitis G is rare as a monoinfection. In a study of patients with chronic hepatitis "neither A, nor B, nor D" conducted in Europe, the USA and Japan, the detection rate of hepatitis G virus in them ranged from 3 to 15%, which is significantly higher than the detection rate of HGV in blood donors, but similar to the detection rate 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.

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Pathomorphology

Pathomorphological examination was mainly performed on liver tissue samples obtained by biopsy of HGV-positive patients with chronic hepatitis C and HGV-positive patients who had undergone liver transplantation. 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 detected in 4 (24%); low, moderate and high activity hepatitis - in 3 (18%), 11 (64%) and 3 (18%), respectively; periportal step necrosis was expressed to the same extent - in 4 (24%), 10 (58%) and 3 (18%). Intralobular necrosis of hepatocytes was detected in 35% of biopsies, balloon hepatocytes - in 18, multinucleated - in 6%. Portal inflammatory infiltration was minor, moderate, or severe in 4 (24%), 12 (70%), and 1 (5%) biopsies, respectively, and was uniformly distributed in the portal spaces; lymphoid aggregates or follicles were detected in 64%, sgeatosis in 82, lymphocytic cholangitis in 12, and cholangiolytic proliferation in 59% of patients. Hemosiderin accumulation in hepatocytes (usually minor) and/or sinusoidal cells was detected in 35% of patients. Nevertheless, pathological changes in liver tissue in isolated HCV infection and combined HCV/HGV infection were almost identical, which casts doubt on the role of HGV in the formation of the above-presented tissue liver pathology. F. Negro et al. (1997) performed liver biopsy in 18 HGV-positive patients who had undergone liver transplantation in the past. In 9 of them, histological changes were associated with transplant rejection (2), acute cholangitis (1), hepatitis C (1) and B (1), steatosis (2). In another 9 patients, histological changes probably associated with HGV infection included the development of lobular (4) or portal (1) inflammation, vacuolization of the biliary epithelium (4), and pronounced lymphocytic infiltration of the portal tracts. G. Cathomas et al. (1997), observing groups of patients with HGV infection, chronic hepatitis C and isolated chronic hepatitis C, found in HCV/HGV infection in liver tissue manifestations of chronic hepatitis of minimal or moderate activity in 61.6 and 23.1% of cases, respectively, as well as signs of progressive fibrosis in 15.4% of cases, and the differences in histological changes in HCV/HGV and only HCV were insignificant.

According to domestic authors, patients with chronic hepatitis G had moderate or minimal inflammatory changes in the liver in the form of portal and lobular hepatitis. The histological activity index (HAI) 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 predominate among patients with CHG. The majority (about 70%) had risk factors for infection with hepatitis viruses - surgical interventions, blood transfusions, intravenous drug use, donation, etc.

Adult patients with CHG as a monoinfection have an asthenic syndrome, manifested by weakness, rapid fatigue, irritability. Patients also complain of pain in the right hypochondrium, a feeling of heaviness in this area; dyspeptic symptoms are noted (nausea, loss of appetite, stool disorders).

An enlarged liver is not observed in all patients with chronic hepatitis G; an enlarged spleen is rare. Yellowing of the sclera is detected in 30-40% of patients.

Liver signs are observed in 10-13% of cases.

More than half of patients with CHG develop biochemical changes. Hyperfermentemia was observed, usually minimal or moderate (ALT and AST exceeded the norm by 2-5 times). In isolated cases, a cholestatic variant of the disease developed.

In mixed infection of HCG with CHC and/or CHB, all clinicians note an insignificant effect of the hepatitis G virus on the functional state of the liver, which is expressed in the absence of “enrichment” of clinical manifestations and an increase in cytolytic syndrome, when compared with clinical and biochemical indicators only with CHC or CHB.

The course and outcome of chronic hepatitis G

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

Children have a similar picture. Chronic hepatitis G can last for a long time, but recovery from the HCV virus can occur, including in mixed infections with CHC.

There are no indications in the literature of the outcome of chronic hepatitis G in liver cirrhosis.

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 has been shown that under the influence of interferon therapy, the concentration of HGV decreases simultaneously with a decrease in the titers of HBV and НСV, while the presence of HGV does not worsen the process in CHB and CHC and does not affect the dynamics of the titers of hepatitis B and C viruses.