Histopathologic Findings of Hepatitis C Virus (HCV) Genotypes 2, 3, and 4 in Liver Biopsies
Richard SP Huang, Ashok Tholpady, Yu Bai, Silva Vitor, Zhao Bihong. The University of Texas, Health Science Center at Houston, Houston, TX
Background: There are at least six known genotypes for HCV and more than 50 subtypes. The most common genotype in the US is type 1 followed by types 2, 3, 4, 5, and 6. Liver biopsies for HCV-infected patients with genotype 1 are commonly performed to assess treatment response and guide treatment regimen. Since liver biopsies are not routinely performed for other HCV genotypes, there is a relative dearth of data for these types. Thus, this study was performed to further characterize histopathologic patterns seen in non-1 HCV genotypes.
Design: This was a retrospective review of 93 patients who had HCV genotype testing between 2007-2011 at an academic medical center. Liver biopsies (where available) were evaluated for stage, grade, and steatosis. In evaluating the liver biopsies, the metavir system was used to score grade and stage between 0-4. Steatosis was scored as mild, moderate, or severe; diffuse or non-diffuse; and micro/macrosteatosis. Demographic data and lab values were collected including HCV viral load and liver function tests (ALT, AST, GGT, alkaline phosphatase, and bilirubin).
Results: Of the 93 patients with non-genotype 1 HCV, biopsies were performed on four HCV-2 infected livers, three HCV-3, one HCV-4, two coinfected with types 1 and 3, and one coinfected with type 1 and 4. There were 9 males, 2 female with a median age of 51 and a range of 29 to 66. The grade, stage, and severity of steatosis for each biopsy is provided in Table 1 along with corresponding lab values. Higher viral loads were typically seen in HCV-2 with mild liver transaminase elevation. The grade and stage for liver coinfected with HCV genotypes were overall more severe than other types singly. Steatosis was seen in all HCV-3 livers.
|TYPE||GRADE||STAGE||STEATOSIS||VIRAL LOAD HCV RNA||LOG10 HCV RNA||AST||ALT|
|2||2||4||moderate macro/micro steatosis||170000||5.2||113||118|
|3||3||3||diffuse moderate macrosteatosis||269000||5.4||182||97|
|3||1||4||mild macro steatosis||6700||3.8||43||63|
|1+3||2||4||focal severe macro steatosis||100000||8||275||313|
|1+4||2||3||mild micro/macro steatosis||777000||5.9||84||77|