CHRONIC HEPATITIS IN MULTIPLE VIRUS-INFECTION - HISTOPATHOLOGICAL EVALUATION

The frequency and histological pattern of multiple hepatitis virus inf ection was studied in 161 Italian patients who had consecutively under gone liver biopsy from 1989 to 1991. The histological features were co mpared with that of infection with a single virus. Thirty-nine per cen t of patients had evidence of past or present multiple infection, the commonest of which was hepatitis C virus (HCV) in patients with eviden ce of previous infection with hepatitis B virus (HBV). In general, the severity of the histological pattern of each viral infection was main tained even when more than one virus was involved; there was neither e xacerbation nor diminution of the histological changes. The delta-viru s (HDV) was not associated with severe necro-inflammatory lesions, but HDV-positive patients were few in this cohort. Lymphoid follicle form ation (a putative histological marker of HCV infection) was also found in a high proportion of HCV-negative patients but expressing much HBc Ag or HDAg in liver tissue. Possible explanations for this finding are that follicles are relatively non-specific for HCV infection, or that these cases represent HCV infection with false-negative serology. The results of this study suggest that multiple hepatitis virus infection is common in the population investigated and that HBV and HCV co-infe ction cannot be reliably diagnosed histologically. Whether double infe ction with these viruses influences the cirrhotic evolution of the liv er lesion remains unclear.