Application of a numerical scoring system for assessment of histological outcome in patients with chronic posttransfusion non‐A, non‐B hepatitis with or without antibodies to hepatitis C

Booth JCL, Foster GR, Levine T, Thomas HC, Goldin RD. The relationship of histology to genotype in chronic HCV infection.Abstract: The histological description of chronic hepatitis is undergoing considerable change at present. It has become important to define chronic hepatitis aetiologically and then define levels of necro-inflanmatory change (grade) and fibrosis (stage). The aim of this study was to compare the ability of different histological scoring systems to detect differences in the pathological changes associated with infection with the different HCV genotypes that are known to have different natural histories. The histological appearances of liver biopsies from 29 HCV infected patients were compared by the Knodell histological activity index (HAI), modified histological activity index and the Scheuer histological scoring system. HCV genotyping was performed for each patient by sequence analysis of the 5' non-coding region. The histological appearances from HCV 1 infected patients showed a tendency towards more active necroinflammatory changes when compared with those from HCV 2 or 3 infected patients. The levels of fibrosis were similar for all genotypes. The modified HA1 and Scheuer scoring systems detected differences, not revealed by the Knodell system, in the types of inflammatory pathology produced by the different genotypes of HCV. In particular these scoring systems noted significant differences in the component scores of inflammation, in addition to the total inflammatory scores. In conclusion, the recently introduced scoring systems were able to detect differences in liver pathology produced by infection of similar duration with different viral genotypes. As genotype is considered an important determinant of disease progression and response to anti-viral therapy, it is likely that those scoring systems correlating with genotype will yield more useful histological information than those that do not.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The relationship of histology to genotype in chronic HCV infection

Booth

Foster

Levine

et al. 1997

“…Patients with chronic PTH-NANB have a marked tendency to progress slowly to cirrhosis, although they are often asymptomatic in the early stages of their disease (2). Histological signs of PMN have been shown to predict a later development of fibrosis/cirrhosis in both chronic hepatitis B (1 1) and chronic PTH-NANB (10). However, PMN in liver specimens from patients with chronic PTH-NANB is much less extensive (10) than in patients with chronic replicating hepatitis B (1 I).…”

Section: Discussionmentioning

confidence: 99%

Histological outcome in interferon alpha‐2b treated patients with chronic posttransfusion non‐A, non‐B hepatitis

Schvarcz

Glaumann

Weiland

et al. 1991

Self Cite

ABSTRACT— The histological outcome in liver biopsies following 9 months of interferon alpha‐2b treatment was assessed in detail in 19 patients with chronic posttransfusion non‐A, non‐B hepatitis (PTH‐NANB) and compared with 12 untreated PTH‐NANB patients. Fourteen (74%) treated and 7 (58%) control patients were reactive for antibodies against hepatitis C virus (anti‐HCV). Liver biopsies taken before and after the 9‐month period were scored numerically for portal inflammation, piecemeal necrosis (PMN) and fibrosis, without knowledge of whether the specimens came from control or treated patients. There were no score differences in the initial biopsies between the treated and control group. In the follow‐up biopsies the treated group showed significantly less portal inflammation, PMN and fibrosis than the control group (p < 0.05–0.01). When paired samples from the treated group were compared, significantly regressed portal inflammation, PMN and fibrosis were noted in the follow‐up biopsies (p < 0.05–0.001). The presence or not of anti‐HCV antibodies in serum had no impact on the histological response to interferon treatment. We conclude that a 9‐month course of interferon alpha‐2b treatment significantly diminishes not only inflammation but also fibrosis in the liver of patients with PTH‐NANB whether they are anti‐HCV reactive or not.

“…The semi-quantitative histological scoring system described by Knodell et al (1 6) blindly applied to sequential liver biopsies has been found useful for the study of the outcome of chronic non-A non-B hepatitis (9), and for the assessment of the effect of interferon therapy on liver damage (12)(13)(14). Treatment with interferon improved all histological parameters, except fibrosis.…”

Section: Biochemical Responsementioning

confidence: 99%

Histological outcome of chronic hepatitis C treated with a 12‐month course of lymphoblastoid alfa interferon

Álava

Camps

Pardo-Mindán

et al. 1993

ABSTRACT— To assess the effect of long‐term alfa interferon therapy (12 months) on liver histology of chronic hepatitis C, we studied 61 treated patients, and compared their outcome with 28 untreated cases followed as controls. A liver biopsy was taken from all patients, before (month 0) and after the completion of the treatment or the control period (month 12). A third liver specimen taken at month 24 was available in 29 treated cases. Liver biopsies were blindly graded following Knodell's method. In 33 out of the 61 treated patients (54.1%), aminotransferase levels became normal shortly after starting therapy and remained within normal values until the end of treatment (sustained response). Nine (27%) sustained responders relapsed after interferon discontinuation, while the remaining 24 (73%) continued with normal aminotransferase values during follow‐up (16.8 ± 9.9 months). All histological parameters, except fibrosis, improved significantly after 12 months of therapy (periportal necrosis, month 0: 2.7 ± 1.0, month 12: 1.6 ± 1.1, p<0.0001; lobular damage, month 0: 2.5 ± 1.1, month 12: 1.4 ± 0.9, p < 0.0001; portal inflammation, month 0: 3.6 ± 0.5, month 12: 3.0 ± 0.9, p<0.0001). Histological improvement was especially marked in patients who did not relapse, although those who relapsed and partial responders also improved. Overall histological diagnoses improved in most patients. A sustained response to inteferon was predicted by high periportal and lobular scores, and by a low fibrosis score on the pretreatment liver biopsy. At 24 months, histological improvement persisted in patients without posttreatment relapse, while liver inflammation had returned to pretreatment levels in the remaining cases.