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[Influence of HIV-related immunodeficiency on the histopathology of chronic hepatitis C]
P M Roger1, V Mondain, M C St Paul
1Service des Maladies infectieuses et tropicales, Hôpital de l'Archet I, Nice.
Insights
Hepatitis C virus (HCV) liver disease severity in human immunodeficiency virus (HIV)-infected patients correlates with immune status. Higher CD8+ T-cell counts are linked to more severe liver pathology, indicating immune system
Area of Science:
- Immunology
- Hepatology
- Virology
Context:
- Human immunodeficiency virus (HIV) infection exacerbates chronic hepatitis C virus (HCV) infection progression.
- Limited data exists on factors influencing liver pathology in coinfected patients, such as duration of HIV infection or T-cell counts.
Purpose:
- To examine liver pathology findings in patients with concomitant HIV and HCV infections.
- To determine the impact of varying levels of immunodepression on liver pathology in coinfected individuals.
Summary:
- Fifty patients with HIV and HCV coinfection were analyzed, categorized by liver pathology severity (cirrhosis/active hepatitis vs. minimal/normal).
- A significant negative correlation was found between liver pathology (Knodell score) and CD4+ and CD8+ T-cell counts.
- CD8+ T-cell counts demonstrated a stronger correlation with liver pathology findings than CD4+ counts.
Impact:
- Liver pathology in HIV/HCV coinfected patients is dependent on the degree of immunodepression.
- CD8+ T-cell counts serve as a more accurate indicator of liver disease severity in coinfected patients compared to CD4+ counts.
- Findings may inform clinical management and prognostication for coinfected individuals.
Objective:
There is substantial evidence demonstrating the aggravating effect of human immunodeficiency virus (HIV) infection on the progression of chronic hepatitis C virus (HCV) infection. There is however, little data on the affect of certain factors which could affect liver pathology findings in patients with concomitant HIV infection such as the duration of HIV infection or T-cell subpopulation counts. We examined pathology findings in patients with concomitant HIV and HCV infections to determine the impact of immunodepression.
Patients And Methods:
We reviewed liver pathology data collected in patients with concomitant HIV and HCV infections grouping patients according to severity of the liver pathology: group 1 = cirrhosis or active hepatitis; group 2 = minimally active hepatitis or histologically normal liver. Transparietal liver biopsies were obtained for the work-up of viral hepatitis or because of long-term unexplained fever or suspected lymphoma. Epidemiological and biological data were obtained from medical files. The duration of the liver disease was estimated from the date of exposure to risk of immunodepression as determined by the peripheral CD4+ and CD8+ counts. All pathology specimens were read by two pathologists who established the Knodell score for each patient.
Results:
Fifty patients were included: 23 were classed in group 1 and 28 in group 2. The Knodell score was significantly different between the two groups, 11 +/- 4 and 4 +/- 3 respectively (p < 0.0001). Disease duration was similar for the two groups: mean 8 years. Mean CD4+ count was significantly higher in group 1: 312/mm3 versus 110/mm3 for group 2 (p = 0.0057); as was the mean CD8+ count (758/mm3 versus 360/mm3, p = 0.0013). For the entire study population, there was a significantly negative correlation (p < 0.05) between the Knodell score and the CD4+ count (r = 0.31) and for the CD8+ count (r = 0.41).
Conclusion:
HCV-related liver pathology in patients co-infected with HIV depends on the level of immunodepression. CD8+ counts are better correlated with pathology findings than with CD4+ counts.