The Role of Hepatitis B Virus and Other Similar Viruses in the Development of Chronic Hepatitis, Cirrhosis and Primary Liver Carcinoma
DOI:
https://doi.org/10.5644/Radovi.260Abstract
The discovery of Australia antigen in 1965 and the subsequent rapid development of knowledge on hepatitis B virus and other viruses, substantially improved our understanding of their role in the development of acute and chronic hepatitis, cirrhosis and primary liver carcinoma.
Hepatitis B virus is not directly cytopathic and the subsequent hepatocyte damage is the result of immune attack to viral antigens, especially to hepatitis B-core antigen (HBcAg). Cytotoxic reaction of peripheral mononuclear cells to own hepatocytes also play an important role in the pathogenesis of chronic liver disease.
In this respect active virus replication have the main influence Which correlates with active stage of chronic hepatitis. The mayor serological markers for HBV replication include HB>Ag, HBV-DNA polymerase activity and HBV-DNA in serum and the presence of HB.Ag in liver. Disappearance of markers of active HBV replication usually marks the resolution of the chronic hepatitis activity and a remission in disease.
Non-A non-B hepatitis is caused by a virus (or viruses) distinct from HAV and HBV and that to date have not been identified. The diagnosis can be made after serological exclusion of known viruses (HAV, HBV, CMV, EBV) and other non-viral causes of hepatocellular injury. It is predominantly blood-borne disease (85—90% of posttransfusion hepatitis are caused by non-A non-B virus), but it can be transmitted by non-percutaneous route and the term “sporadic non-A non-B hepatitis” has been adopted.
The delta agent, discovered in 1977 by Rizzeto and co-workers, is a defective RNA virus that needs hepatitis B virus for its replication and expression. Infection by the delta agent can occur as a coinfection with hepatitis B, which usually causes acute hepatitis, or as e superinfection of a hepatitis B carrier and its outcome is related to the type and course of existing HBV infection.
Delta infection is universal but its geographical distribution is irregular. A high prevalence of infection is found in South Europe (especially in Southern Italy), Africa, South America and Middle East. According to the present data the prevalence of delta infection in chronic HB-Ag positive liver disease in *Yugoslavia is around 10%.
The role of hepatitis B virus in the development of primary liver carcinoma is today dominant occupation of many investigators, because some different facts support the hypothesis that persistent infection with HBV is required for the development of most cases of primary hepatocellular carcinoma. These are: good geographic correlation between high prevalence areas for chronic carriers of HBV and the high incidence areas for PHC, high incidence of persistent HBV infection among patients with PHC, high proportion of mothers of patients with PHC are carriers of HBV, the finding of HBsAg, and less commonly HBcAg, in the liver tissue of most cases of PHC, integration of HBV DNA in the tumour cells, and a very high relative risk for a HBsAg carrier to develop PHC (more than 250 times that of a non-carrier).
But, in spite of many advances in this field, the correct mechanisms of PHC pathogenesis is still unknown. Primary hepatocellular carcinoma is probably result of interaction of many factors (genetic, immunologic, nutritional and hormonal as well as mitotoxins Chemical carcinogens and other environmental agents).
Hepatitis B virus acts like carcinogen or cocarcinogen in infected. Hepatocytes i. e. as a trigger of many sequences whose final result is a primary liver carcinoma.
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