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The etiology of chronic hepatitis in Italy: a multicenter study
G Giusti1, E Sagnelli, C Gallo
1Clinic of Infectious Diseases, School of Medicine, Second University of Naples, Italy.
Insights
This study on chronic hepatitis (CH) in Italy (1980-1989) found viral infections were the leading cause, with Hepatitis B virus (HBV-CH) and likely Hepatitis C virus (HCV-CH) being most common. Alcohol abuse and autoimmune factors were also identified.
Area of Science:
- Hepatology
- Virology
- Epidemiology
Background:
- Chronic hepatitis (CH) etiology was investigated in Italy between 1980-1989, a period preceding widespread Hepatitis C Virus (HCV) diagnosis.
- Understanding the causes of CH is crucial for public health and patient management.
Purpose of the Study:
- To retrospectively analyze the etiological spectrum of chronic hepatitis in Italy during a specific decade.
- To identify trends and demographic differences associated with various chronic hepatitis causes.
Main Methods:
- A multicenter retrospective study reviewed 5,461 patients with chronic hepatitis.
- Data collected included etiology, patient demographics, and histological findings.
Main Results:
- Hepatitis B virus (HBV-CH) accounted for 31.3%, Hepatitis D virus (HDV-CH) for 5.5%, autoimmune hepatitis markers for 3.0%, and post-transfusion NANB CH for 3.7%.
- Alcohol abuse was implicated in 10.9%, with 42.5% classified as cryptogenic CH, likely due to undiagnosed HCV.
- Geographical variations showed higher HDV-CH in the south and alcoholic CH in the north. HBV-CH cases decreased post-1984, with a rising mean age.
Conclusions:
- Hepatitis viruses were the primary cause of chronic hepatitis in Italy during 1980-1989, with HBV and likely HCV being dominant.
- Distinct demographic and geographical patterns were observed for different etiologies.
- A decline in HBV prevalence and an increase in the mean age of HBV-CH patients suggest reduced HBV endemicity in Italy.
Abstract:
In a multicenter retrospective study, we reviewed the etiology of chronic hepatitis (CH) in Italy during the period 1980-1989, before the laboratory diagnosis of HCV hepatitis had become possible. Among the 5,461 patients investigated, 31.3% had HBV-CH, 5.5% HDV-CH, 3.0% serological markers of autoimmune hepatitis and 3.7% post-transfusion NANB CH. Alcohol abuse was considered responsible in 10.9% of the cases and a diagnosis of crytogenic CH was made in 42.5%. Considering that most cryptogenic cases were actually due to chronic HCV infection, we may assume that as many as two-thirds of our cases were due to a hepatitis virus infection. Some differences were observed between patients with chronic hepatitis of different etiologies. Drug abuse was frequently recorded only in HDV-CH; patients with HBV-CH and HCV-CH were younger than those in other etiological groups; a histological picture of chronic active hepatitis was more frequently recorded in HDV-CH and autoimmune CH. The only identifiable geographical differences observed were a higher prevalence of HDV-CH in the south and of alcoholic chronic liver diseases in the north. During the period under observation, we noted a clear reduction in the percentages of HBV chronic hepatitis cases after 1984 and, accordingly, the mean age of HBV-CH progressively increased from 1980 to 1989 by almost a year each year. This observation is in agreement with recent data suggesting a reduction in HBV endemicity in Italy in recent years.