The nomenclature of chronic hepatitis: time for a change
1995; Elsevier BV; Volume: 22; Issue: 1 Linguagem: Inglês
10.1016/0168-8278(95)80269-x
ISSN1600-0641
Autores Tópico(s)Hepatitis C virus research
ResumoT” histological subdivision of chronic hepatitis into chronic persistent and chronic active forms was first advocated nearly 30 years ago (1,2). The underlying purposes of this classification were first to clarify the use of the term chronic active hepatitis, and secondly to distinguish between mild disease, chronic persistent hepatitis, with a low potential for cirrhosis, and more aggressive forms which might lead to cirrhosis by the process of piecemeal necrosis. Chronic lobular hepatitis was added to the classification shortly afterwards (3) to indicate a predominantly lobular (acinar) lesion, and the term chronic septal hepatitis was introduced to describe scarring without piecemeal necrosis (4). The classification was widely adopted by clinicians and pathologists alike. There are several good reasons why this simple histological classification no longer meets the needs of hepatologists. Foremost is the rapid increase in understanding of hepatitis virus infection, the main cause of chronic hepatitis. In 1968, when the histological classification was published, the hepatitis B virus had only recently been discovered (5) and little was known about its replication and behaviour in chronic infections. The hepatitis A virus was discovered a few years later (6). Testing for antibodies to the most important non-A, non-B virus followed in 1989 and enabled hepatitis C infection to be identified (7,8). All histological forms and degrees of severity of chronic hepatitis are found in both hepatitis B and C, but they sometimes have quite different clinical and prognostic implications. To give an example, in patients with hepatitis B in a phase of low viral replication (HBeAg negative, anti-HBe positive, low serum HBV-DNA) the histological appearances are typically those of chronic persistent hepatitis. For these patients the risk of developing cirrhosis is low, though not en-
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