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Viruses
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Viral Hepatitis and Liver Diseases
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Viral Hepatitis and Liver Diseases

A special issue of Viruses (ISSN 1999-4915). This special issue belongs to the section "Human Virology and Viral Diseases".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 7229

Special Issue Editor

Dr. Carlo Smirne

E-Mail Website
Guest Editor
Associate Professor of Internal Medicine, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
Interests: viral hepatitis; epidemiology of hepatitis C; hepatitis C treatment; hepatitis B; liver fibrosis; liver cirrhosis; hepatocellular carcinoma; autoimmune hepatitis; nonalcoholic steatohepatitis

Special Issue Information

Dear Colleagues,

Viral hepatitis is defined as an inflammation of the liver caused by viral pathogens that may cause severe hepatic disease. Its long-term sequelae, especially hepatocellular carcinoma and hepatic failure, have been recognized as serious problems in all parts of the world, particularly in the Asia–Pacific region, Africa, Latin America and Southern Europe. In fact, the burden of viral hepatitis remains substantial—both global and liver-specific—despite recent advances in antiviral therapy and effective measures to prevent infection at least for some viral types. The most common hepatitis viruses are types A, B, C, D and E (commonly referred to as HAV, HBV, HCV, HDV and HEV). However, many other viruses can lead to viral hepatitis, including human immunodeficiency virus (HIV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), herpes simplex virus (HSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and flaviviruses. Even though their effects on the liver and the symptoms they produce can be similar, the severity and duration of the disease are determined by the specific virus that caused it.

This Special Issue of Viruses welcomes original research, short communications and review articles that will contribute to an improved understanding of aspects such as the epidemiology of new emerging viruses causing liver diseases; new, viral-hepatitis-related molecular mechanisms of the immune response and of liver damage (including, but not limited to, liver fibrosis and hepatocellular carcinoma); and other relevant topics relating to viruses with proven liver toxicity (such as cutting-edge developments in their diagnosis, transmission or therapeutics).

Dr. Carlo Smirne
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Viruses is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic viral infection
  • viral hepatitis
  • liver fibrosis
  • hepatocellular carcinoma
  • hepatitis B virus
  • hepatitis C virus
  • hepatitis delta virus co-infection
  • hepatitis E virus
  • flavivirus
  • molecular mechanisms
  • epidemiological investigations

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Published Papers (6 papers)

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Research

Jump to: Review

8 pages, 215 KiB  
Communication
Hepatitis B Hospitalizations in Brazil: Temporal and Regional Patterns from 2008 to 2023
by Danielle Satie Kassada, Igor de Lima Peixoto Rocha and Leonardo Dresch Eberhardt
Viruses 2025, 17(3), 348; https://doi.org/10.3390/v17030348 - 28 Feb 2025
Viewed by 462
Abstract
Hepatitis B remains a significant global public health concern, particularly in low- and middle-income countries, where prevention and control measures often face challenges. In Brazil, substantial efforts have been made over the years to combat the burden caused by hepatitis B through public [...] Read more.
Hepatitis B remains a significant global public health concern, particularly in low- and middle-income countries, where prevention and control measures often face challenges. In Brazil, substantial efforts have been made over the years to combat the burden caused by hepatitis B through public health interventions, including vaccination programs, antenatal screening, and prevention of vertical transmission. However, despite these advancements, disparities in disease trends persist across regions and vulnerable populations, requiring ongoing analysis and intervention. This study aimed to analyze the trend in hospital admissions for hepatitis B in Brazil from 2008 to 2023. Data were collected from the SUS Hospital Information System. Statistical analyses were conducted using the Joinpoint Regression Program (version 5.0.2), applying a 5% significance level to identify significant trends over the study period. A total of 19,735 hospitalizations for hepatitis B were recorded during the study period. The overall trend showed a significant decline in hospital admissions, reflecting the effectiveness of public health interventions such as expanded vaccination coverage, screening programs, and prevention strategies. Despite this overall decline, notable regional disparities were observed. The midwest region exhibited an increasing trend in hospitalizations, contrasting with the national decline. Furthermore, a concerning rise in hospital admissions among infants under one year of age was identified, indicating potential shortcomings in the prevention of the vertical transmission of the virus. This study highlights both the successes and persistent challenges in controlling hepatitis B hospitalizations in Brazil. Maintaining high vaccination coverage and implementing targeted public health campaigns for vulnerable populations are crucial for sustaining progress. The regional disparities and failures in vertical transmission prevention require continued attention and intervention to advance toward the goal of eliminating hepatitis B as a public health threat in Brazil. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
15 pages, 599 KiB  
Article
Prevalence and Risk Factors of Occult HCV Infection in the Adult Population of Mexico City
by Luis Antonio Uribe-Noguez, María Erandhi Prieto-Torres, Luis Octavio Uribe-Noguez, José Antonio Mata-Marín, Carla Ileana Arroyo-Anduiza, Rebeca Paquentín-Jimenez, Alberto Chaparro-Sanchez, Wendy Guadalupe Vazquez-Gonzalez, Andrea Santos Coy-Arechavaleta, Ericka Nelly Pompa-Mera, Jesus Gaytán-Martínez, Julio Elias Alvarado-Yaah, Clara Esperanza Santacruz-Tinoco and Alicia Ocaña-Mondragón
Viruses 2025, 17(2), 236; https://doi.org/10.3390/v17020236 - 8 Feb 2025
Viewed by 952
Abstract
Occult HCV infection (OCI) is defined by the presence of HCV RNA in hepatocytes and/or peripheral blood mononuclear cells (PBMCs) without detectable HCV RNA or anti-HCV antibodies in plasma. OCI is underrecognized and may contribute to HCV transmission. This study estimated OCI prevalence [...] Read more.
Occult HCV infection (OCI) is defined by the presence of HCV RNA in hepatocytes and/or peripheral blood mononuclear cells (PBMCs) without detectable HCV RNA or anti-HCV antibodies in plasma. OCI is underrecognized and may contribute to HCV transmission. This study estimated OCI prevalence and associated risk factors in adults from Mexico City. Methods: A retrospective cross-sectional study was conducted, analyzing 507 general population volunteers. Demographic data and potential risk factors were collected via questionnaire. Anti-HCV detection was performed using two techniques: immunochromatographic rapid test and chemiluminescent microparticle immunoassay (CMIA). Nested PCR was employed to detect HCV RNA in plasma and PBMCs. Positive samples were genotyped through sequencing and phylogenetic analysis of the Core/E1 region. Results: Of 507 participants, four were anti-HCV positive. HCV RNA was found in PBMCs of 27 individuals, while plasma samples tested negative, indicating a 5.3% OCI prevalence. OCI was significantly associated with blood donation (p = 0.015), drug use (p = 0.019), particularly cocaine (p = 0.001), and endoscopy (p = 0.043). Genotypes 1b, 1a, 2b, 3a, and 2j were detected in OCI cases. Conclusions: OCI prevalence in Mexico City’s general population is notable, with significant links to blood donation, cocaine use, and endoscopy. Enhanced diagnostic strategies are crucial to detect OCI and mitigate HCV transmission. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
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11 pages, 1195 KiB  
Article
Decrease in HBsAg After TAF Switching from Entecavir During Long-Term Treatment of Chronic Hepatitis B Virus Infection
by Kazuto Tajiri, Yuka Hayashi, Aiko Murayama, Nozomu Muraishi, Masami Minemura and Ichiro Yasuda
Viruses 2025, 17(1), 44; https://doi.org/10.3390/v17010044 - 31 Dec 2024
Viewed by 981
Abstract
Achieving HBsAg seroclearance is a key goal in treating chronic hepatitis B virus (HBV) infection but remains difficult with nucleos(t)ide analogues (NAs). Tenofovir alafenamide fumarate (TAF), a recommended NA for managing chronic HBV infection (CHB), has uncertain effects on HBsAg levels and potential [...] Read more.
Achieving HBsAg seroclearance is a key goal in treating chronic hepatitis B virus (HBV) infection but remains difficult with nucleos(t)ide analogues (NAs). Tenofovir alafenamide fumarate (TAF), a recommended NA for managing chronic HBV infection (CHB), has uncertain effects on HBsAg levels and potential adverse events when used long-term after switching from entecavir (ETV). We retrospectively evaluated 77 CHB patients, including 47 who switched from ETV to TAF with a median follow-up of 40 months post-switch and a median of 60 months of HBsAg monitoring pre-switch. No significant change in HBsAg levels was observed in the overall cohort post-switch, consistent with the ETV continuation group. However, a significant decrease in HBsAg was noted in patients with HBsAg < 100 IU/mL at the time of switching. HBsAg loss occurred in three patients who switched to TAF. No adverse effects were observed, and TAF was well tolerated. The most significant factor associated with achieving HBsAg < 100 IU/mL was the Fib-4 index, a marker of liver fibrosis, at the time of switching. Switching from ETV to TAF is an effective strategy in CHB management, with hepatic inflammation potentially playing an essential role in achieving HBsAg decrease. Patients with increased Fib-4 index were significantly more likely to show decreased HBsAg. This finding suggests patients with mild to moderate fibrosis may respond better to TAF in terms of HBsAg reduction. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
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13 pages, 880 KiB  
Article
Bridging Hepatitis C Care Gaps: A Modeling Approach for Achieving the WHO’s Targets in Ontario, Canada
by Yeva Sahakyan, Aysegul Erman, William W. L. Wong, Christina Greenaway, Naveed Janjua, Jeffrey C. Kwong and Beate Sander
Viruses 2024, 16(8), 1224; https://doi.org/10.3390/v16081224 - 31 Jul 2024
Viewed by 1337
Abstract
Background: The World Health Organization (WHO) has set hepatitis C (HCV) elimination targets for 2030. Understanding existing gaps in the “HCV care-cascade” is essential for meeting these targets. We aimed to identify the level of service scale-up needed along the “HCV care-cascade” to [...] Read more.
Background: The World Health Organization (WHO) has set hepatitis C (HCV) elimination targets for 2030. Understanding existing gaps in the “HCV care-cascade” is essential for meeting these targets. We aimed to identify the level of service scale-up needed along the “HCV care-cascade” to achieve the WHO’s HCV elimination targets in Ontario, Canada. Methods: By employing a decision analytic model, we projected the quality-adjusted life years (QALYs) and healthcare costs for individuals with HCV in Ontario. We increased RNA testing and treatment rates to 98%, followed by increasing antibody testing uptake until we achieved the WHO’s mortality target (i.e., a 65% reduction in liver-related mortality by 2030 vs. 2015). Results: Without scaling up by 2030, the expected QALYs and costs per person were 9.156 and CAD 48,996, respectively. Improved RNA testing and treatment rates reduced liver-related deaths to 3.3/100,000, a 57% reduction from 2015. Further doubling the antibody testing rates can achieve the WHO’s mortality target in 2035, but not in 2030. Compared to the status quo, such program would be cost-effective considering a 50,000 CAD/QALY gained threshold if annual implementation costs stayed under 2.3 M CAD/100,000 people. Conclusions: Doubling the antibody testing rates, along with increased RNA testing and treatment rates, showed promise in meeting the WHO’s goals by 2035. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
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Review

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15 pages, 1728 KiB  
Review
The Impact of Antiretroviral Therapy on Liver Function Among Pregnant Women Living with HIV in Co-Existence with and Without Pre-Eclampsia
by Kay-Lee E. Strauss, Wendy N. Phoswa and Kabelo Mokgalaboni
Viruses 2025, 17(1), 28; https://doi.org/10.3390/v17010028 - 28 Dec 2024
Viewed by 1087
Abstract
Pregnant women living with HIV (PWLWHIV) are at an increased risk of developing obstetrics complications such as pre-eclampsia (PE). Antiretroviral therapy (ART) remains the standard treatment for PWLWHIV and non-pregnant women. However, its use has been associated with adverse liver conditions, particularly hepatotoxicity, [...] Read more.
Pregnant women living with HIV (PWLWHIV) are at an increased risk of developing obstetrics complications such as pre-eclampsia (PE). Antiretroviral therapy (ART) remains the standard treatment for PWLWHIV and non-pregnant women. However, its use has been associated with adverse liver conditions, particularly hepatotoxicity, often marked by elevated liver enzymes (LEEs) as demonstrated by an increased aspartate transferase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) in PWLWHIV on ART. Morever, there is limited evidence about the effect of ART on liver function among PWLWHIV and PE. Therefore, this review examines the pathogenesis of PE and the impact of ART on liver function in PWLWHIV with and without PE. With the evidence gathered in this review, it is still unclear whether liver dysfunctions in PWLWHIV in co-existence with orwithout PE result from HIV infection or ART administration or are exacerbated by the presence of PE. Among those without PE, there was an increase in liver enzymes, a decrease, and no effect in other studies in ART-treated PWLWHIV compared to the control group. Additionally, among those with PE, the impact of ART remains unclear due to contradicting results. The notable trend was that nevirapine was associated with a reduced risk of liver dysfunction among PWLWHIV without PE. Therefore, more studies are needed in this area, especially in HIV endemic regions, to understand the exact cause of liver dysfunction in this population. This knowledge is crucial for improving liver function and PE management among PWLWHIV. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
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26 pages, 699 KiB  
Review
Chronic Hepatitis C Infection Treated with Direct-Acting Antiviral Agents and Occurrence/Recurrence of Hepatocellular Carcinoma: Does It Still Matter?
by Carlo Smirne, Maria Grazia Crobu, Irene Landi, Nicole Vercellino, Daria Apostolo, David James Pinato, Federica Vincenzi, Rosalba Minisini, Stelvio Tonello, Davide D’Onghia, Antonio Ottobrelli, Silvia Martini, Christian Bracco, Luigi Maria Fenoglio, Mauro Campanini, Alessandro Maria Berton, Alessia Ciancio and Mario Pirisi
Viruses 2024, 16(12), 1899; https://doi.org/10.3390/v16121899 - 10 Dec 2024
Viewed by 1606
Abstract
Hepatitis C virus (HCV) infection is a significant risk factor for liver cirrhosis and hepatocellular carcinoma (HCC). Traditionally, the primary prevention strategy for HCV-associated HCC has focused on removing infection through antiviral regimes. Currently, highly effective direct-acting antivirals (DAAs) offer extraordinary success across [...] Read more.
Hepatitis C virus (HCV) infection is a significant risk factor for liver cirrhosis and hepatocellular carcinoma (HCC). Traditionally, the primary prevention strategy for HCV-associated HCC has focused on removing infection through antiviral regimes. Currently, highly effective direct-acting antivirals (DAAs) offer extraordinary success across all patient categories, including cirrhotics. Despite these advancements, recent studies have reported that even after sustained virologic response (SVR), individuals with advanced liver disease/cirrhosis at the time of DAA treatment may still face risks of HCC occurrence or recurrence. Based on this premise, this review tries to shed light on the multiple mechanisms that establish a tumorigenic environment, first, during chronic HCV infection and then, after eventual viral eradication by DAAs. Furthermore, it reviews evidence reported by recent observational studies stating that the use of DAAs is not associated with an increased risk of HCC development but rather, with a significantly lower chance of liver cancer compared with DAA-untreated patients. In addition, it seeks to provide some practical guidance for clinicians, helping them to manage HCC surveillance of patients who have achieved SVR with DAAs. Full article
(This article belongs to the Special Issue Viral Hepatitis and Liver Diseases)
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