The liver is involved in infections by hepatotropic viruses that replicate in the liver and for which the liver is the main target. These include hepatitis A (HAV), B (HBV), C (HCV), D (HDV) and E (HEV) viruses. In all of these infections, hepatitis and liver damage arise as a consequence of the immune response to virus within the liver (1-6). We, retrospectively, studied 75 patients with HCV related chronic liver disease. We concluded that latent infections by hepatomimetic viruses may play a crucial role in the progression of liver disease in HCV-infected patients and may deteriorate the prognosis of those patients in relation with the response to combination therapy. However, further studies of a greater number of cirrhotic and HCC-related HCV patients are needed in order to clarify the role of ''silent'' CMV and/or EBV infection in HCV patients (75). As occult hepatitis B infection is an important clinical entity, which may progress to severe sequelae, some other yet-to-be determined factors, including hepatomimetic viruses, play a key role to the progression of chronic hepatitis C and its response to combination therapy. In agreement with most studies, environmental, genetic and immunologic determinants are involved in the development of occult hepatitis B, latent CMV and EBV infections and the consequent liver cirrhosis, HCC and the decreased response to combination therapy in HCV-infected patients. These certain risk factors should be included in a long-term follow-up study on HCV patients. Repeated measurements of HBV infection markers (antiHBs, antiHBc, HBV DNA) and PCR for CMV and EBV in combination with periodic health examinations of study subjects may provide useful information on their clinical outcome and identify development and progression of occult hepatitis B, CMV and EBV and its related liver diseases.
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