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Background-Chronic hepatitis C virus infection associated with contaminated anti-D immunoglobulin has become an issue of recent concern. The clinical course of chronic hepatitis C infection is unpredictable and histological assessment is felt to be the most reliable means of assessing disease status. Semiquantitative scoring systems have been devised, which assess degree of necroinflammatory disease activity (grade) and extent of disease progression with fibrosis (stage) in chronic hepatitis. Often, using these systems, biopsies of anti-D associated chronic hepatitis C cases show mild changes only, with low scores. The significance of these low scores is uncertain. Aims-To evaluate the significance of low scores in chronic hepatitis. Methods-Liver biopsies were assessed from two groups of patients in whom liver histology would be expected to be normal: 30 cases of Gilbert's syndrome and 13 necropsy cases of young people (< 45 years) with no history or risk factors for liver disease. These biopsies were scored using the histological activity index of Knodeil et al and its recent modification (separation of scores for grade and stage) by Ishak et al. Results-Twenty of 30 cases of Gilbert's syndrome and 11 of the 13 necropsy cases had chronic hepatitis scores of 1 or 2, whereas only eight cases of Gilbert's and two necropsy cases had scores of 0. The remaining two Gilbert's cases had scores of 3 and 5. Similar results were found using both the histological activity index of Knodeli et al and the method of Ishak et al. Conclusion-The finding of low but positive scores using these systems in people with normal liver histology questions the reliability and significance of finding such scores in patients with chronic hepatitis and is of particular concern in the evaluation of chronic hepatitis C infection. (C Clin Pathol 1997;50:929-931)

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To assess the frequency and nature of thyroid abnormality in association with interferon (IFN) therapy alone and in combination with ribavirin, 19 patients receiving IFN therapy for hepatitis C virus (HCV)-induced liver disease had thyroid function tests assessed on a monthly basis. Group I (n = 9) patients received 5 million U of IFN s.c. daily for 2 weeks, followed by 3 million U three times per week for 6 months. Group II (n = 10) patients received 3 million U IFN s.c. three times per week together with ribavirin 400 mg twice daily orally for 6 months. Five of 19 patients (26.3%) developed thyroid abnormalities, 3 (33.3%) in group I and 2 (20%) in group II. Three patients developed thyroid function tests consistent with hyperactivity, and 2 of these normalized on cessation of IFN therapy. One patient continued on IFN but remained clinically euthyroid with antithyroid treatment. Two patients developed thyroiditis and required thyroid supplementation. (One of the 2 had pretreatment antimicrosomal thyroid antibodies and a positive family history of thyroid disease.) Of the 3 patients with HCV type 1b, 1 had pretreatment thyroid antibodies, and all 3 had antibodies during IFN therapy. Neither of the 2 patients with genotype 3 had pre-IFN or post-IFN thyroid antibodies. Patients on IFN therapy need regular thyroid function testing. The frequency of abnormal thyroid tests may be dose related. HCV genotype may influence the development of thyroid antibodies.

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