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Related Concept Videos

Hepatitis01:25

Hepatitis

Hepatitis is an inflammatory condition of the liver most commonly caused by hepatotropic viruses (A–E), though non-infectious causes such as alcohol and drugs also exist.Hepatitis AHepatitis A virus (HAV) is a non-enveloped RNA virus of the Picornaviridae family. It is primarily transmitted via the fecal-oral route, typically through ingestion of contaminated food or water. After ingestion, HAV enters the bloodstream through the oropharynx or intestinal epithelium and reaches the liver. The...
Viral Hepatitis I: Introduction01:28

Viral Hepatitis I: Introduction

Viral hepatitis is an inflammatory condition of the liver caused by infection with hepatotropic viruses, most commonly hepatitis A, B, C, D, and E. Despite variations in structure and transmission, all viruses mentioned infect hepatocytes and provoke immune responses that can hinder liver function. Additionally, some non-hepatotropic viruses can also lead to hepatic inflammation.Hepatitis A VirusHepatitis A virus (HAV) is transmitted through the fecal–oral route, typically by ingestion of food...
Cirrhosis I: Introduction01:23

Cirrhosis I: Introduction

Cirrhosis is a chronic, irreversible liver disease characterized by the widespread replacement of healthy liver tissue with fibrotic scar tissue and the formation of regenerative nodules.Etiology of cirrhosisCirrhosis results from sustained liver injury that triggers progressive fibrosis and structural remodeling. The underlying causes are diverse, encompassing common and less frequent clinical conditions. Regardless of the origin, all causes lead to chronic inflammation, hepatocyte loss, and...
Cirrhosis II: Pathophysiology01:24

Cirrhosis II: Pathophysiology

Cirrhosis is a progressive chronic liver injury caused by prolonged inflammation, excessive fibrotic remodeling, and impaired regeneration. Over time, repeated hepatic insults disrupt the liver’s architecture and function, leading to reduced blood flow, impaired bile drainage, and diminished metabolic capacity.Pathophysiology of cirrhosisCirrhosis arises from three main responses to chronic liver damage: inflammation, immune activation, and hepatocyte death. These processes lead to structural...
Chronic Pancreatitis I: Introduction01:25

Chronic Pancreatitis I: Introduction

Chronic pancreatitis is a long-standing, relapsing inflammation of the pancreas, characterized by irreversible damage to the gland. It results in progressive destruction of the pancreatic parenchyma, fibrosis, and eventual loss of both exocrine and endocrine function. The disease may evolve gradually after multiple episodes of acute pancreatitis or develop independently.EtiologyChronic pancreatitis can arise from a variety of causes:Alcohol use is the leading cause, accounting for 70–80% of...
Chronic Pancreatitis I: Introduction01:24

Chronic Pancreatitis I: Introduction

The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...

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Chronic Hepatitis E as a cause for cryptogenic cirrhosis in HIV.

Gurmit K Jagjit Singh1, Samreen Ijaz, Neesha Rockwood

  • 1HIV & Sexual Health Department, Chelsea and Westminster Hospital, London, United Kingdom. gurmit.jagjitsingh@chelwest.nhs.uk

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Chronic Hepatitis E infection can cause persistent liver inflammation in individuals with HIV. Early diagnosis and treatment with pegylated interferon can lead to viral clearance, suggesting its consideration in HIV-associated liver disease.

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Area of Science:

  • Hepatology
  • Virology
  • Immunology

Background:

  • Chronic Hepatitis E virus (HEV) infection is a recognized complication in immunocompromised individuals.
  • Human Immunodeficiency Virus (HIV) infection compromises the immune system, potentially increasing susceptibility to chronic infections.

Observation:

  • A 45-year-old HIV-positive male presented with unexplained persistent elevation of liver enzymes (transaminitis).
  • Advanced liver disease, including cirrhosis, was diagnosed via hepatic elastography and liver biopsy.
  • Serological testing confirmed Hepatitis E virus (HEV) infection (IgM/IgG positive), with HEV RNA detected in plasma.

Findings:

  • Archived samples indicated HEV viremia dating back to the year 2000, suggesting a long-standing infection.
  • Treatment with a 24-week course of pegylated interferon resulted in undetectable HEV RNA by week 4 of therapy.
  • Viral clearance was sustained for 27 weeks post-treatment cessation.

Implications:

  • Chronic HEV infection should be considered in the differential diagnosis of unexplained transaminitis and cryptogenic liver cirrhosis in HIV-infected patients.
  • Early detection and antiviral therapy, such as pegylated interferon, can be effective in managing chronic HEV in this population.
  • This case highlights the importance of considering opportunistic viral infections in immunocompromised individuals with chronic liver disease.