[1634] Histologic and Clinical Features of Patients with Chronic Hepatitis C with Autoimmune Features

RK Pai, M Westerhoff, E Jenkins, H Te, J Hart. Washington University, St. Louis; Univ. of Chicago, Chicago

Background: Detailed histologic features of patients with chronic hepatitis C (HCV) and superimposed autoimmune features (HCV+AIH) have not been described in a large series. Furthermore, no study has analyzed the outcome of these patients following therapy (antiviral or immunosuppression). In this study we compared patients with HCV+AIH with those with pure HCV and pure AIH.
Design: Patients with HCV+AIH based on histology and autoimmune markers (+ANA or +ASMA) from 1999 -2008 were identified from the liver and pathology databases (n=28). HCV alone patients matched for age, gender, and race served as controls (n=49). Of the 22 HCV patients tested for ANA, 9 had low titer positivity. Pure AIH patients (n=38) with pretreatment biopsies were also identified. Clinical and laboratory data were collected. Cases were blindly graded and staged (Batts and Ludwig) by 2 pathologists. Other histologic variables recorded included degree of plasma cell and eosinophil infiltrates, and the presence of lymphoid aggregates, steatosis, and rosetting.
Results: Histologic characteristics of HCV, HCV+AIH and AIH patients are shown in Table 1. Patients with HCV+AIH had advanced fibrosis and extensive interface activity compared with HCV patients. Mean HCV RNA (million IU/ml) in HCV+AIH and HCV patients was 1.5+/-0.2 and 2.5+/-0.4 respectively. Baseline ALT (IU/ml) was higher in HCV+AIH patients compared with HCV controls: 140+/-120 versus 62+/-69. 27 HCV+AIH patients underwent therapy (15 IFN-based, 8 IFN+immunosuppression, and 4 immunosuppresion alone). Of the 23 patients who underwent IFN-based therapy, 6 had complete viral eradication with few immune side effects.

Histologic characteristics of patients with CHC, AIH, and CHC+AIH
HCV (% of patients)AIH (% of patients)HCV+AIH (% of patients)p-value (HCV vs. HCV+AIH
Grades 3-467875p<0.001
Stages 3-421239p<0.001
Plasma cells (≥2+)47250p<0.001
Eosinophils (≥2+)82229p=0.02
Lymphoid aggregates633186p=0.06

Conclusions: HCV+AIH is a distinct entity with greater necroinflammatory activity, ALT and fibrosis compared to patients with HCV alone. The presence of grade 3-4 necroinflammatory activity and/or a prominent portal infiltrate of plasma cells should prompt the pathologist to report the possibility of HCV+AIH and recommend a serum ANA to confirm the diagnosis. IFN-based therapy leads to viral eradication in 26% of cases with few immune-mediated side-effects.
Category: Liver & Pancreas

Monday, March 22, 2010 1:00 PM

Platform Session: Section D, Monday Afternoon


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