The prevalence of chronic liver disease, cirrhosis, and ESLD is steadily increasing. Chronic liver disease is currently the tenth leading cause of death among adults in the United States and accounts for 25,000 deaths yearly, or 1 percent of all deaths. The majority of ESLD (approximately 50 percent) is related to alcohol abuse. However, in recent decades, an increasing number of cases can be attributed to chronic viral hepatitis. 12. and 3

Currently, hepatitis C virus (HCV) infection is the most common of all bloodborne infections in the United States, with approximately 28,000 to 180,000 new cases yearly. An estimated 3.9 million (1.8 percent) Americans have been infected. Chronic HCV infection occurs in 85 percent of patients, and chronic liver disease follows in as many as 70 percent of patients. It is further estimated that 40 percent of chronic liver disease is now related to HCV infection and results in 8000 to 10,000 deaths yearly. For perspective, HIV-related deaths number approximately 14,000 yearly. The majority of HCV-infected individuals are in the age group 30 to 49 years, and infection is often subclinical, with symptoms of chronic liver disease and cirrhosis delayed 1 to 2 decades. Therefore, it is anticipated that the number of cases of chronic liver disease related to HCV will increase sharply in the next 10 to 20 years. 45

Effective vaccination against hepatitis B virus (HBV) has lead to a decline in the prevalence of related disease in the general population. Still, there are an estimated 140,000 to 320,000 cases of HBV infection yearly, with 140 to 320 deaths due to acute infections. Chronic HBV infection occurs in 6 to 10 percent of patients, with 5000 to 6000 related deaths yearly. There are currently 1 to 1.25 million Americans with chronic HBV infection. 6

The hepatitis D virus (HDV) is uncommon and described as a defective agent because infection depends on concomitant or preexisting chronic infection by HBV. In individuals with chronic HBV infection, superinfection with HDV often results in a rapidly progressive or fulminant form of liver disease carrying a high short-term mortality rate. This variety of infection is most commonly associated with intravenous drug use.2,3

Hepatitis A virus (HAV) is commonly encountered by Americans, with 33 percent of the population having acquired immunity secondary to exposure. There are approximately 125,000 to 200,000 cases of HAV infection reported yearly, with an estimated 100 related deaths. Fulminant liver failure is a rare complication of HAV infection, and chronic infection does not occur.27

Acute illness with liver function test abnormalities also occurs with infection by other hepatotropic viruses such as cytomegalovirus (CMV), herpes simplex virus, Coxsackie virus, and Epstein-Barr virus (EBV), although these agents are unlikely to cause clinically evident hepatitis and jaundice in otherwise healthy individuals.

Alcoholic liver disease and viral hepatitis comprise the vast majority of cases of acute and chronic liver disease. Other causes include a variety of toxins, idiosyncratic drug reactions, and autoimmune and metabolic hepatobiliary diseases (T.a.b.!e 8.2.-1 and Table.82-2). The epidemiology and clinical features of these disorders are not discussed but are referenced.1,7,8. and 9

TABLE 82-1 Causes of Acute and Chronic Hepatitis

TABLE 82-2 Causes of Chronic Liver Disease and Cirrhosis

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