Current anatomico-pathological classification of hepatitis: characteristics of HCV infection

Area of Science:

• Hepatology
• Pathology
• Gastroenterology

Background:

• Advances in understanding chronic hepatitis natural history and etiology necessitate revised histopathological classifications.
• Effective treatments for chronic hepatitis have emerged, prompting updates in diagnostic and prognostic criteria.

Purpose of the Study:

• To outline the revised histopathological classification of chronic hepatitis.
• To highlight the key histological features and diagnostic tools for chronic hepatitis.
• To emphasize the role of liver biopsy in managing chronic hepatitis.

Main Methods:

• Review of basic lesions in chronic hepatitis: portal inflammation, piecemeal necrosis, lobular inflammation, and fibrosis.
• Assessment of histological activity using Knodell's score or Histological Activity Index (HAI).
• Evaluation of specific histological features associated with hepatitis C virus (HCV) infection.

Main Results:

• Chronic hepatitis classification revised to better accommodate hepatitis C virus-linked cases.
• Key lesions include inflammatory infiltrates, necrosis, and fibrosis, with HAI assessing activity and stage.
• Specific HCV-associated features include leukaemia-type infiltrates and lymphoid aggregates.

Conclusions:

• Liver biopsy is essential for confirming chronic hepatitis diagnosis, determining grade and stage, and guiding treatment.
• Revised classifications improve the assessment of chronic hepatitis, particularly HCV-related forms.
• Histological findings, though sometimes non-specific, provide valuable diagnostic support.