2.2.1 Chronic Active and Chronic Persistent
2.2.1 Chronic persistent or chronic active - what’s the difference?
Hepatitis C is considered to be “chronic” if it has persisted for longer than 6 months. The term “Chronic Persistent” used to be used to define hepatitis which persisted for longer than 6 months, but which was not currently causing active damage to the liver.
The term “Chronic Active” was used to define hepatitis which persisted for longer than 6 months, and which was actively destroying the liver. The distinction between “persistent” and “active” is not commonly used any more, with the assumption being that if the virus is present, it is causing damage.
About 85% of HCV-infected individuals fail to clear the virus by 6 months, and develop chronic hepatitis with persistent, although sometimes intermittent, viremia. This capacity to produce chronic hepatitis is one of the most striking features of HCV infection. The majority of patients with chronic infection have abnormalities in ALT levels that can fluctuate widely. About one-third of HCV patients with chronic infection have persistently normal serum ALT levels. Antibodies to HCV or circulating viral RNA can be demonstrated in virtually all patients with chronic HCV hepatitis.
Chronic HCV is typically an insidious process, progressing, if at all, at a slow rate without symptoms or physical signs in the majority of patients during the first two decades after infection.
A small proportion of patients with chronic HCV hepatitis - perhaps less than 20 percent - develop nonspecific symptoms, including mild intermittent fatigue and malaise. Symptoms first appear in many patients with chronic HCV hepatitis at the time of development of advanced liver disease. If by advanced we mean cirrhosis, then this is most definitely not the case. Symptoms can occur well before cirrhosis occurs.
Although patients with HCV infection and normal ALT levels have been referred to as “healthy” HCV carriers, liver biopsies can show histological evidence of chronic hepatitis in many of these patients. - National Institutes of Health Consensus Statement on Hepatitis C 1997
It is thus possible to have low enzyme levels and few if any symptoms and yet have dangerously advanced liver disease. The problem with this scenario is that the carrier does not know he or she is ill, and does not make modifications to his or her behavior—alcohol consumption, sexual protection, fatty foods, and so forth.
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