[Post-hepatitis B, B-D and C cirrhosis]

Three viruses are responsible for posthepatitic cirrhosis: hepatitis B virus, hepatitis D (also called delta) virus and hepatitis C virus formerly known as non-A, non-B virus. Delta virus is a defective organism which can replicate only when coinfection with hepatitis B virus is present. These three viruses cause chronic active hepatitis which, after a period of 5 to 30 years, gives rise to posthepatitic cirrhosis. Chronic infections with these viruses account for more than 90 p. 100 of chronic active hepatitis in France and constitute a major cause of cirrhosis. Beside complications (hepatocellular insufficiency, portal hypertension, hepatocellular carcinoma) which are common to all types of cirrhosis irrespective of their origin, the course of posthepatitic cirrhosis is characterized by possible episodes of reactivation of chronic hepatitis and by a very high risk of hepatocellular carcinoma. Two kinds of treatment are now available: antiviral therapy (basically with interferon alpha) and liver transplantation. Antiviral therapy must, of course, be given before the stage of cirrhosis has been reached. Liver transplantation in these patients raises special problems due to recurrence of viral infection in the graft. Vaccination against hepatitis B virus, which also prevents the B-delta coinfection, must be systematic in populations at risk.