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What causes chronic hepatitis?
Last reviewed: 06.07.2025
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Most often, the formation of chronic hepatitis is etiologically associated with hepatitis viruses.
- Chronic hepatitis is caused by viruses, mainly transmitted parenterally:
- hepatitis C virus (HCV) is detected in 30-50% of cases in children with chronic hepatitis;
- hepatitis B virus (HBV) - in 15-20% of cases, usually simultaneously with the delta virus (HDV);
- hepatitis F, G viruses - less than 1% of cases;
- cytomegalovirus, herpes, rubella, enterovirus, Epstein-Barr virus - very rare, mainly in young children.
Chronic hepatitis can be a consequence of toxic liver damage:
- chemical substances (benzene derivatives, organochlorine compounds, heavy metal salts);
- drugs (isoniazid, sulfonamides, valproic acid and carbamazepine, phenytoin, androgenic hormones, methyldopa, acetaminophen, salicylates, hydralazine, nitrofurans, cytostatics).
Chronic hepatitis may develop against the background of bacterial and parasitic diseases (septic endocarditis, brucellosis, tuberculosis, amebiasis, opisthorchiasis, infectious mononucleosis).
Pathogenesis of chronic hepatitis
The leading moments of chronic hepatitis are:
- persistence of the virus in the body with insufficient ability of the body to eliminate the virus from the liver;
- development of an immunopathological aggressive process in the liver.
The features of the immune response are largely determined by genetic factors. This is evidenced by the presence among patients of a significant number of individuals with histocompatibility antigens HLA - B8, DRw3 and A1.
As chronic hepatitis develops in the liver, the following occurs:
- progressive destruction of the parenchyma with death of hepatocytes, inflammatory and immunopathological changes in the mesenchyme,
- decreased blood supply and microcirculation disorder;
- dysfunction of hepatocytes not damaged by infection;
- cholestasis.
Classification of chronic hepatitis (Los Angeles, 1994)
Form |
Activity |
Stage |
Phase |
Chronic viral hepatitis (B, delta, C, G, F) Autoimmune hepatitis Chronic toxic or drug-induced hepatitis |
Minimum (> ALT up to 3 times) Moderate (> ALT up to 10 times) Expressed (>ALT more than 10 times) Inactive hepatitis |
Mild Moderate fibrosis with portoportal septa Marked fibrosis with portocentral septa Disruption of lobular structure Formation of |
With viral hCG Integration replications |