LIVER HISTOPATHOLOGY IN PATIENTS WITH CONCURRENT CHRONIC HEPATITIS-C AND HIV-INFECTION

To investigate the influence of human immunodeficiency virus (HIV) coi nfection on preexisting long-term chronic C hepatitis (HCV) 68 liver b iopsies from 22 HIV/HCV-coinfected, 13 HIV- and 33 HCV-monoinfected pa tients and 71 livers obtained at autopsy from 26 HIV/HCV-coinfected an d 45 HIV-monoinfected patients were studied by histo- and immunohistoc hemistry. All HIV patients had reached the advanced stage of immunodef iciency (stage III CDC), except for 3 haemophiliacs (stage II CDC). HC V infection was associated with a higher degree of portal, periportal and lobular inflammation - regardless of whether there was concurrent HIV infection. HIV/HCV coinfection was associated with a significantly higher rate of granulocytic cholangiolitis than HCV and HIV monoinfec tion (P < 0.05), a histological feature uncommon in C hepatitis. In HI V/HCV coinfection cholestasis was a predominant histological feature. HCV monoinfection and HCV/HIV coinfection were associated with the hig hest fibrosis index. In HIV/HCV coinfection centrilobular fibrosis was significantly more marked than in HCV monoinfection (P < 0.05), sugge sting an HIV-associated fibrogenic effect. Patients with chronic C hep atitis showed a significantly increased rate of posthepatitic cirrhosi s compared with the patients without HCV infection (P < 0.05). At auto psy, 10 of the 20 HIV/HCV-coinfected haemophiliacs had developed cirrh osis because of chronic C: hepatitis, whereas cirrhosis was found in o nly 2 of 6 HIV/HCV-coinfected non-haemophiliacs (1 case of chronic B a nd C hepatitis, and 1 case of chronic alcohol abuse). No cirrhosis was observed in the 45 autopsy patients with HIV monoinfection. The findi ngs suggest that HIV coinfection aggravates the course of preceding lo ng-term chronic C hepatitis by a more marked (centrilobular) fibrosis. HIV/HCV-coinfected patients are threatened by a higher rate of posthe patitic cirrhosis particularly in multitransfused haemophiliacs - and cholestatic hepatopathy.