Overview of the histopathology of chronic hepatitis B infection

Abstract

About two billion people worldwide have been infected with the hepatitis B virus and about 350 million live with chronic infection. Besides, an estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. The course of HBV infection is a dynamic process and is influenced by many factors including viral, host, and exogenous factors. Clinical suspicion of acute viral hepatitis usually does not necessitate biopsy; however, persistence of clinical symptoms or biochemical evidence of hepatotrophic viral infection for more than six months duration necessitates a liver biopsy - in several instances to primarily establish the histopathological diagnosis, to grade and stage the hepatic changes (determine management and prognosis), to document the severity and extent of the hepatic inflammation, as a guide to therapy or to monitor the changes of liver histology while on treatment. Moreover, improvement in liver histology can be used as an endpoint in clinical trials for new forms of therapy. Additionally, in some cases there is considerable clinical overlap between the states of exacerbation of chronic hepatitis and acute hepatitis. Biopsy is helpful in these cases too. Nevertheless, it must be mentioned that with the current trends and various guidelines, the indications for liver biopsy in chronic hepatitis B are somewhat reduced. It is hoped that with non-invasive markers the number of liver biopsies will reduce further. This article provides an overview of the histopathology of chronic hepatitis B virus infection.