Chronic hepatitis and other liver disease

Abstract Approximately one of every 40 deaths worldwide can be attributed to liver cirrhosis and primary liver cancer (hepatocellular carcinoma, HCC). In this chapter, we will focus on the epidemiology and public health impact of the main aetiologies of chronic liver disease, i.e. viral hepatitis B and C, and alcoholic as well as non-alcoholic fatty liver diseases. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major risk factors in the development of HCC either by inducing cirrhosis or by direct oncogenic effects. Hepatitis B is a significant health issue across the world, mainly in Asia and Africa but also in the industrialized countries. However, unlike hepatitis C and HIV, it has not captured sufficient attention from policymakers, advocacy groups or the general public. Globally, 57 per cent of cirrhosis cases and 78 per cent of HCC have been attributed to either HBV or HCV. As hepatitis B and C share modes of transmission their combined occurrence is not uncommon, particularly in areas where both viruses are endemic, and in individuals at high risk of parenteral infection (e.g. drug users). It has long been known that alcohol consumption is responsible for increased illness and death. The spectrum of liver pathology caused by alcohol consumption goes from steatosis, over cirrhosis to hepatocellular carcinoma. Thirty-two per cent of all cases of cirrhosis worldwide are estimated to be attributable to alcohol. Worldwide, alcoholic liver disease may increase in the next several decades. Recent data indicate that alcohol consumption is increasing in low- and middle-income countries. In addition, rates of excessive alcohol intake appear to be rising in women. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are chronic liver diseases associated with the metabolic syndrome. This tends to take epidemic proportions in the Western population, and to constitute a major health problem in the near future. Despite the availability and widespread use of vaccines against hepatitis B, it will still take many years before its chronic consequences will be effectively controlled on a global scale. In the meantime, hepatitis C prevention and control will form a major challenge to those involved in public health, especially since the development of vaccines against hepatitis C still has not resulted in a success. On top of the chronic liver diseases caused by viral hepatitis, increasing alcohol consumption and the rising epidemiology of non-alcoholic chronic liver diseases will increasingly require our attention in the future.