[1424] Spectrum of Liver Pathology and Laboratory Findings in HIV Patients with and without Hepatitis C Coinfection.

Jeffrey A Eisenstein, Matthew G Lim, Matthew M Coates, Marina B Mosunjac. Emory University, Atlanta, GA

Background: Liver abnormalities are common in HIV patients. The reported prevalence and the impact of HIV/HCV coinfection vary significantly among studies. The aim of this study was to evaluate histological, clinical and laboratory findings in HIV patients of an inner-city hospital,with and without Hepatitis C (HCV) coinfection
Design: Clinical and pathologic data was obtained on 168 HIV-positive patients with liver biopsies (LB) from the years 2005-2010 at Grady Memorial Hospital. A retrospective search of medical records categorized patients by age, sex, biopsy indication, pathologic diagnosis and hepatitis serologies.
Results: Patients age ranged from 22-69 (mean 46.5) years with a 2.4:1 male to female ratio. 137 patients were co-infected with HCV. Of the 137 patients, 44 were additionally coinfected with Hepatitis B (HBV). We identified 31 HCV seronegative patients, 8 whom were co-infected with HBV. The remaining 23 patients had HIV only and had LBs for various clinical and laboratory indications including elevated liver enzymes.

	ALT [IU/L] range; mean; SD	ALT [IU/L] range; mean; SD	# Stage 3 and 4 (%)
Hep C+, Hep B- (N=93)	13-304; 70.7; 61.3	13-466; 71.5; 64.3	25 (26.9)
Hep C-, Hep B- (N=23)	11-203; 92.5; 66.8	17-613; 183.4; 187.1	4 (17.4)
Hep C+, Hep B+ (N=44)	20-398; 74.9; 70.3	21-888; 101.1; 138.1	15 (34.1)
Hep C-, Hep B+ (N=8)	23-507; 120.5; 160.1	29-914; 197.3; 296.4	4 (50)

Biopsy results for the patients coinfected with HCV demonstrated an overall higher level and incidence of fibrosis. There was one case of hepatocellular carcinoma, one case of ductopenia, and a case of metastatic large-cell neuroendocrine carcinoma from the lung.
Biopsy results for patients who were HCV-seronegative demonstrated the following: Non-specific hepatitis (12), B-virus-related hepatitis (8), two of which were cirrhotic, AFB+ granulomas (2), non-specific AFB- granulomas (2), increased iron stores suggestive of hemochromatosis (2), Kaposi's sarcoma (1), involvement by CLL/SLL (1), primary biliary cirrhosis (1), benign liver cyst (1), and unremarkable liver parenchyma (4).
Conclusions: The incidence of coinfection with HCV in HIV patients of an inner-city hospital is high (81.55%). Coinfected patients show higher degree of fibrosis and cirrhosis however; there were no significant difference in liver enzyme levels than in those patients with HIV alone. Surprisingly, overall, only a small proportion of LB contained malignancy or opportunistic infection and there were no biopsies that would suggest drug-associated reaction.
Category: Infections

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 228, Wednesday Afternoon