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.
|HCV (% of patients)||AIH (% of patients)||HCV+AIH (% of patients)||p-value (HCV vs. HCV+AIH|
|Plasma cells (≥2+)||4||72||50||p<0.001|