Histological findings in chronic hepatitis C with autoimmune features

Abstract

struction. 11 In other instances, they may identify individuals To evaluate the histological findings in patients with who respond adversely to interferon therapy, [12][13][14][15][16] and who chronic hepatitis C and autoimmune features, liver tissue might benefit from corticosteroid treatment. [17][18][19] In these latter specimens from 60 patients were graded under code for indicases, the autoimmune features may characterize a subgroup vidual features and composite patterns that denoted autoimwith immune-predominant pathogenic mechanisms. mune, viral, combined autoimmune and viral, and nondis-The bases for liver cell destruction in chronic hepatitis C criminative changes. Portal, interface, and acinar hepatitis in are uncertain, but immunologic and direct viral-mediated any combination with plasma cell infiltration connoted an cytopathic processes have been proposed. 20 Intraportal autoimmune pattern that was associated with higher serum lymphoid nodules contain CD4 / , CD8 / , and activated T cells levels of g-globulin (2.4 { 0.2 g/dL vs. 1.7 { 0.1 g/dL; P Å that resemble the infiltrates in autoimmune hepatitis 21,22 ; cy-.0003) and immunoglobulin G (2,211 { 227 mg/dL vs. 1,508tokine-dependent molecules, such as the class I and class II { 83 mg/dL; P Å .001) than patients with other patterns.HLA and immune adhesion molecules, have been shown on Patients with the autoimmune pattern also had a greater frethe hepatocytes and bile duct cells of infected patients 23 ; and quency of cirrhosis (43% vs. 8%; P Å .003), higher mean clones of T lymphocytes reactive to antigens of the hepatitis Knodell score (13.2 { 0.9 vs. 6.8 { 0.9; P õ .0001), and C virus are found in the liver tissue of propositi. 24 These a greater occurrence of high-titer smooth muscle antibodies observations support the concept of an immunopathic disor-(SMA) (13% vs. 0%; P Å .05) than patients with other histoder. logical findings. HLA DR3 also occurred more frequently in Direct cytopathicity by the virus has also been implicated. 20 these individuals than in other patients (48% vs. 15%; P Å Hepatitis C virus is a member of the flavivirus family and is .01) and normal subjects (43% vs. 16%; P Å .01). Patients with nondiscriminative patterns and interface hepatitis had cytopathic by nature. 25 The sparseness of the inflammatory clinical findings similar to those with autoimmune patterns, infiltrate in some patients, 26 the correlation between cytodeexcept for a lower mean serum level of g-globulin. We con-struction and the intrahepatic concentrations of virus, 27 and clude that the composite histological pattern that resembles the ability of antiviral drugs to influence disease expression autoimmune hepatitis is associated with greater immunoreac-by suppressing or eliminating viremia 28,29 suggest a direct tivity, inflammatory activity, and disease severity than other viral injury. Perhaps immunopathic and cytopathic mechapatterns. Interface hepatitis may be the most important histo-nisms are present concurrently in individual patients with logica...

Direct acting antiviral therapy is curative for chronic hepatitis C/autoimmune hepatitis overlap syndrome

“…In most cases, titers are usually low, and cases with positive serologies are in general histologically indistinguishable from those without detectable antibodies. However, patients with an autoimmune overlap syndrome in whom liver biopsies reveal features of both chronic hepatitis C and inflammatory features charac teristic of AIH are occasionally encountered [4] . The treatment of patients with HCV/AIH overlap syndrome has until recently been challenging.…”

Clinical Characteristics of Patients with Hepatitis C Virus-Related Chronic Liver Disease Seropositive for Anticentromere Antibody

“…The higher age of our CH-C patients with ACA may have been responsible for the more progressive disease. On the other hand, Czaja and Carpenter [36] noted that CH-C patients with autoantibodies, including ANA and/or SMA, had higher HAI scores and a lower frequency of hepatic steatosis than CH-C patients lacking these autoantibodies. We confirmed that both hepatic fibrosis and inflammation in patients with CH-C seropositive for ANA were significantly more severe than that those in patients with CH-C seronegative for ANA ( Table 2).…”

“…The degrees of grading are classified from A0 to A3. We also evaluated hepatic steatosis, bile duct damage, and lymphoid follicles, which are histological characteristics of CH-C [32][33][34][35][36][37]. The revised scoring system for a diagnosis of AIH, which was proposed by the International Autoimmune Hepatitis Group [38], was applied to each patient with CH-C seropositive for ACA in order to rule out a diagnosis of AIH.…”

Treat-to-Target in Autoimmune Hepatitis: How Far To Go?

“…The Ishak system is funded based on viral hepatitis, mainly describing the intensities of inflammatory activities and structural progression of the liver diseases. However, in the histology of AIH, interface hepatitis, plasma cells infiltration, rosettes and emperipolesis are typical histological features [32,33]. A recent study suggests that emperipolesis and rosette formation are superior histological predictors of AIH than classic hallmark features, such as interface hepatitis and plasma cells infiltration [34].…”