Liver biopsy and the etiologic diagnosis of chronic hepatitis

The histological features of chronic viral hepatitis differ according to etiological agent and replicative phases. Thus, in chronic HBV hepatitis with a high level of HBV replication the histological lesion is generally mild. During the seroconversion phase, a lobular lesion is present in the liver biopsy followed by amelioration of the disease. Chronic delta hepatitis is very aggressive histologically, progression to cirrhosis is frequent, and sanded nuclei are often observed in liver biopsies of patients with anti-HIV. In contrast, chronic hepatitis C shows a milder histological picture and immunohistochemical techniques to detect HCV-Ag in the liver tissue should be developed. In summary, the majority of cases of chronic viral hepatitis have distinctive histological features that may be identified in liver biopsies.