Possible Complications

Hepatitis B

The course and sequelae of chronic HBV infection are diverse and variable.

  • Some HBV-infected people will exhibit a low viraemic inactive carrier state, while others will experience progressive hepatitis that can evolve to cirrhosis and hepatocellular carcinoma (HCC)1
  • PLWHIV are at increased risk of progression of HBV-related fibrosis1
    • refer to the page on risk factors (link to: Hepatitis Co-infection / Disease information overview / Risk factors) for additional risk factors for progression of HBV-related liver disease
    • a downloadable document is available on the classification and management of patients with cirrhosis
  • Severe hepatitis flares can occur in HBV-HIV co-infected patients with low CD4 cell counts who experience immune reconstitution after initiation of ART2
  • As well as serious hepatic consequences, HBV infection can be associated with extra-hepatic manifestations, including:
    • polyarteritis nodosa
    • glomerulonephritis3

Hepatitis C

  • The long-term impact of HCV infection is highly variable, from minimal changes in some people to hepatic inflammation, fibrosis progression, cirrhosis and HCC in others4
  • PLWHIV are at increased risk of progression of HCV-related fibrosis compared with individuals infected with HCV but not HIV4
    • refer to the page on risk factors for additional risk factors for progression of HCV-related liver disease
  • In the general population, there is evidence to suggest that people with HCV infection are more prone to the development of steatosis (fatty liver disease) than people without HCV infection
    • the relationship between HCV and steatosis is currently unclear; however, HCV genotype 3 is thought to be associated with increased risk of developing steatosis5
    • steatosis is associated with lower virologic response and worsening fibrosis irrespective of antiviral treatment6
  • As well as serious hepatic consequences, HCV infection can be associated with extra-hepatic manifestations, including:4
    • cryoglobulinemia
    • lichen planus
    • porphyria cutanea tarda
    • lymphocytic sialoadenitis
    • membranous glomerulonephritis
    • non-Hodgkin lymphoma4

References

  1. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines: Management of Chronic Hepatitis B. J Hepatol 2009;50:227–242. Accessed 1 December 2011.
  2. American Association for the Study of Liver Diseases (AASLD). Practice Guideline. Chronic Hepatitis B: Update 2009. Accessed 1 December 2011.
  3. Terrier B, Cacoub P. Hepatitis B virus, extrahepatic immunologic manifestations and risk of viral reactivation. Rev Med Interne 2011;32:622–627.
  4. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines: Management of Hepatitis C Virus Infection. J Hepatol 2011;55:245–264. Accessed 1 December 2011.
  5. Asselah T, Rubbia‐Brandt L, Marcellin P, Negro F. Steatosis in chronic hepatitis C: why does it really matter? Gut 2006;55(1):123–130.
  6. Szanto P, Grigorescu M, Dumitru I, Serban A. Steatosis in hepatitis C virus infection. Response to anti-viral therapy.  J Gastrointestin Liver Dis. 2006;15(2):117-124.