Chronic hepatitis at Groote Schuur Hospital: 1978-1996 : a literature review of the syndrome, its clinical spectrum and management at Groote Schuur Hospital
Chronic hepatitis has multiple aetiologies which include viral hepatitis (hepatitis B, B+D and C), autoimmune hepatitis and drugs. In sub-Saharan Africa the major aetiological factor is chronic hepatitis B virus infection. In this region 10-15% of the population is chronically infected with the virus and 76% have serological evidence of past exposure to the hepatitis B virus. HDV infection has not been documented in Southern Africa but studies from Northern Africa show antibody positivity for HDV of 21-31 % in patients with chronic HBV infection. Drug-induced hepatitis is also increasingly being recognised as a significant entity. This study arose from the observation that there are a significant number of patients with autoimmune hepatitis on follow-up at the Groote Schuur Hospital liver clinic. This group includes patients who test negative for the standard autoimmune markers done at Groote Schuur Hospital but have liver histology that is typical of classical autoimmune hepatitis. They also show a clinical and biochemical response to steroid and azathioprine therapy that is indistinguishable from that seen in classical autoimmune hepatitis cases on similar treatment. This study is retrospective and covers the period 1978 - 1996. The patients studied are those with chronic hepatitis as defined by the International Working Party in 1995, i.e. patients with necro-inflammatory disease of the liver lasting at least 6 months. This includes hepatitis B, B + D, C, autoimmune hepatitis and drug-induced liver disease. Several other liver diseases that may present with clinical and histological features of chronic hepatitis are specifically excluded. These include Wilson's disease, Primary biliary cirrhosis, Primary sclerosing cholangitis, alpha-1-antitrypsin deficiency, alcohol abuse and iron over load states.
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