Hepatitis Viruses and Metabolic Factors in Liver Disease

Hepatites Non A-E ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evidence for Additional Hepatitis Agents ,[object Object],[object Object],[object Object],[object Object],[object Object]

VHG : GBV-C, 95 % homology VHG : HCV, 29 % homology

HGV Epidemiology and Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]

HGV Epidemiology and Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prevalence of Serum HGVRNA in Acute Hepatitis of Viral Origin ,[object Object],[object Object],[object Object],[object Object],% * : p<0.05 vs HAV and HCV Alter M, NEJM 1997

HGV : is it an Hepatotropic Virus ? Pessoa, Hepatology 1998

HGV : is it an Hepatotropic Virus ? ,[object Object],[object Object],Pessoa, Hepatology 1998

HGV has no Pathogenic Role on the Course of Acute Hepatitis ,[object Object],[object Object],[object Object]

HGV and Transfusion associated Hepatitis (TAH) ,[object Object],[object Object],[object Object],[object Object],A CAUSAL RELATION BETWEEN HGV AND TAH IS NOT ESTABLISHED Alter H, NEJM 1997

HGV in End-Stage Liver Disease and Liver Transplantation ,[object Object],[object Object],[object Object],Fried, Hepatology 1997 Pessoa, Hepatology 1998

Does HGV Impact on the Course of other Viral Infections? ,[object Object],[object Object]

No Histopathologic Impact of HGV on Chronic Hepatitis C ,[object Object],[object Object],[object Object],[object Object],HGV INFECTION DOES NOT MODIFY THE COURSE OF CHRONIC HCV INFECTION CONTRIBUTION TO LIVER DISEASE LESS THAN OTHER HEPATOTROPIC VIRUSES Bralet, Gastroenterology 1997

Establishing Causality for New Viruses ,[object Object],[object Object],[object Object],[object Object],[object Object],Alter, Postgraduate Course, AASLD 2000

Chronic Liver Disease - Beyond the Viruses ... ,[object Object],[object Object]

Etiologie de la Cirrhose (n=78) Etude Dionysos (Hepatology 1994) HCV 28 % HBV 9 % HBV+ ALCOOL 3 % HEMO CHROMATOSE 1 % ALCOOL 26 % CBP 1 % HCV+ ALCOOL 3% CRYPTOGENIC 24 %

Factors Associated with ALT Levels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Piton, Hepatology 1998 Prati, Ann Intern Med 2002

What is a Normal ALT Value ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Piton, Hepatology 1998 Prati, Ann Intern Med 2002

Clinical Implications of the Different Thresholds for Normal ALT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Piton, Hepatology 1998 abnormal ALT

Chronic Liver Disease - Beyond the Viruses ... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Impact of Overweight on Chronic Liver Disease ,[object Object],[object Object],[object Object],BMI (kg/m 2 ) % Relative Risk (CI 95%) Dionysos Study, n = 1211 (6917 total) (Bellentani Hepatology 1994)

Proportion of Patients With Cryptogenic Cirrhosis according to BMI - UNOS Database > 40 BMI 35 - 40 30 - 35 25 - 30 < 25 HCV Alcohol Cryptogenic N =19271 % (Nair, Hepatology 2002)

Obésité et Cirrhose Cryptogénétique Cirrhose X NASH Cirrhose C CBP N Age Obésité (%) Femmes (%) Diabète (%) 70 50 39 33 63 (+/- 11) 49(+/- 14 ) 60 (+/-7) 54 (+/-10) 70 56 36 100 47 64 3 15 53 42 25 15 Caldwell, Hepatology 1999

[object Object],[object Object],[object Object],Liver Histology in Overweight Patients n = 858 ; 9 studies, 1978 - 2002

Prevalence of NASH/NAFLD ,[object Object],[object Object],[object Object],[object Object]

Hepatic Fibrosis in NASH ,[object Object],[object Object],[object Object],% n= 572, 9 studies 1980 - 2001

Risk Factors for Severe Fibrosis in NASH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ratziu, Gastroenterology 2000 Angulo, Hepatology 1999 Dixon, Gastroenterology 2001

Abnormal Liver Function Tests ,[object Object],[object Object],[object Object],[object Object]

Hepatitis Viruses and Metabolic Factors in Liver Disease

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Hepatitis Viruses and Metabolic Factors in Liver Disease

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