INFLUENCE OF HEPATITIS-C VIRUS GENOTYPES AND HIV-INFECTION ON HISTOLOGICAL SEVERITY OF CHRONIC HEPATITIS-C

Objectives: The factors influencing the histological severity of chron ic hepatitis C (CHC) have not been well established. We therefore inve stigated the effect of hepatitis C virus (HCV) genotypes and human imm unodeficiency virus (HIV) infection on histological liver damage in a cohort of intravenous drug users with CHC. Methods: We analyzed the hi stological activity score and the HCV genotypes in 59 HCV-RNA-positive patients with biopsy-proven CHC. Forty-eight (81%) of them had concom itant HIV infection with a CD4(+) cell count above 200 x 10(6) cells/L and an absence of AIDS-defining conditions. Multivariate analysis was performed to determine the features associated with the histological severity. Results: Minimal/mild hepatitis was found in 16 patients (27 %), moderate chronic hepatitis in 29 (49%), and severe chronic hepatit is in 14 (24%). Patients with HCV subtype 1b had a higher histological score than others (8.7 +/- 3.3 vs. 6.5 +/- 3.2, p = 0.012), either as single or mixed infections. In multivariate analysis, HIV-infected in dividuals had a higher score of piecemeal necrosis (OR = 21.7, p = 0.0 02) and a higher stage of fibrosis (OR = 17.9, p = 0.004) than patient s without HIV infection. HIV infection and HCV genotype 1b were found to be independent factors of histological severity. Conclusions: Liver damage in patients with CHC seems to be directly influenced by HCV su btypes. Infection by HCV subtype 1b is closely associated with more se vere forms of liver pathology. Furthermore, the presence of HIV infect ion is an independent factor associated with more aggressive histologi cal damage. In these patients, higher degrees of piecemeal necrosis an d fibrosis are commonly seen.