The aetiology of chronic hepatitis in Italy: results from a multicentre national study.
BACKGROUND
No recent national-level data on the aetiology of chronic hepatitis are available in Italy.


OBJECTIVE
To evaluate the current aetiology of chronic hepatitis in Italy.


METHODS
A total of 6210 chronic hepatitis patients (both prevalence and incident cases) consecutively admitted to 79 hospitals located throughout Italy were enrolled over a 6-month period in 2001. The hospitals were randomly selected through systematic cluster sampling.


RESULTS
The main agent associated with chronic hepatitis was hepatitis C virus, which was found in 76.5% of the patients (in 62.6% it was the only aetiologic factor). Hepatitis B surface antigen was present in the serum of 12.2% of the cases (in 9.2% it was the only aetiologic factor). Hepatitis B e antigen and hepatitis Delta were detected in 16.6% and 7.0%, respectively, of hepatitis B surface antigen-positive patients. A history of alcohol abuse was found in 19.2% of the cases (5.5% without viral infection). Autoimmune hepatitis and inborn metabolic disorders were extremely rare. The prevalence of hepatitis C virus-related cases was significantly lower in incident cases, compared to prevalent cases (55.1% versus 65.0%; p < 0.01). The mean alanine aminotransferase level was significantly higher in hepatitis B surface antigen-positive patients, compared to hepatitis B surface antigen-negative patients. The histology was less severe in non-viral-related cases.


CONCLUSIONS
Hepatitis C virus is the most important pathogenic factor for chronic hepatitis in Italy; however, the comparison between prevalent and incident cases suggests that this infection will play a less important role in the future. A comparison with previous reports shows that both hepatitis B virus-related and hepatitis Delta virus-related cases are decreasing.
Stroffolini
T
T
Laboratory of Epidemiology, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy. wenzel@iss.it
Sagnelli
E
E
Mele
A
A
Craxì
A
A
Almasio
P
P
D000328:Adult; D001327:Autoimmune Diseases / Q000453:epidemiology; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D019701:Hepatitis D, Chronic / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence