THE RELATIONSHIP OF HISTOLOGY TO GENOTYPE IN CHRONIC HCV INFECTION

The histological description of chronic hepatitis is undergoing consid erable change at present. It has become important to define chronic he patitis aetiologically and then define levels of necro-inflammatory ch ange (grade) and fibrosis (stage). The aim of this study was to compar e the ability of different histological scoring systems to detect diff erences in the pathological changes associated with infection with the different HCV genotypes that are known to have different natural hist ories, The histological appearances of liver biopsies from 29 HCV infe cted patients were compared by the Knodell histological activity index (HAI), modified histological activity index and the Scheuer histologi cal scoring system, HCV genotyping was performed for each patient by s equence analysis of the 5' non-ending region. The histological appeara nces from HCV 1 infected patients showed a tendency towards more activ e necroinflammatory changes when compared with those from HCV 2 or 3 i nfected patients. The levels of fibrosis were similar for all genotype s. The modified HAI and Scheuer scoring systems detected differences, not revealed by the Knodell system, in the types of inflammatory patho logy produced by the different genotypes of HCV In particular these sc oring systems noted significant differences in the component scores of inflammation, in addition to the total inflammatory scores. In conclu sion, the recently introduced scoring systems were able to detect diff erences in liver pathology produced by infection of similar duration w ith 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 wil l yield more useful histological information than those that do not.