Histological Features Of Chronic Hepatitis Research Articles

Hepatitis C virus RNA in serum and liver histology in asymptomatic anti-HCV positive subjects.

This study was designed to evaluate serum HCV-RNA, liver histology, and RIBA-II pattern in asymptomatic anti-HCV positive subjects with persistently normal or slightly (i.e. < or = 1.5 times the upper limit of the normal range) elevated serum ALT levels. To this purpose, 22 asymptomatic anti-HCV positive subjects (11 men and 11 women, median age 40, range 21-70 years) underwent liver biopsy and determination of serum HCV-RNA. Positivity for anti-HCV was determined by ELISA-2 and by RIBA-II. Serum HCV-RNA was determined by PCR. Our data show that: 1) 9/22 symptom-free, anti-HCV positive subjects had histological features of chronic liver disease associated with ongoing HCV infection; 2) four subjects had no histological signs of chronic hepatitis and normal serum ALT levels despite positivity for serum HCV-RNA; 3) serum ALT levels did not discriminate HCV-RNA positive subjects with from those without chronic hepatitis; 4) in anti-HCV positive subjects with normal serum ALT levels, a positive RIBA-II pattern was not always predictive of HCV viraemia or chronic hepatitis while an indeterminate RIBA-II pattern was frequently associated with nonspecific liver changes or normal histology. In conclusion, based on these findings, "true" healthy carriers of HCV (i.e. subjects with normal serum ALT levels and no histological features of chronic hepatitis despite HCV viraemia) may exist.

Histological features of chronic hepatitis C

Histological features of chronic hepatitis C

Hepatitis C virus antibodies in a long-term follow-up of beta-thalassaemic children with acute and chronic non-A non-B hepatitis.

The presence of antibodies toward hepatitis C virus (HCV) was examined in 78 polytransfused beta-thalassaemic children. The anti-HCV status was correlated with acute and chronic non-A non-B (NANB) hepatitis that developed during a follow up of about 13 years. Anti-HCV was present in 83.3% of children with acute NANB hepatitis and in 82.9% of those with chronic NANB hepatitis. The percentage of chronic evolution was 56.7% for acute anti-HCV positive NANB hepatitis and 50.0% for anti-HCV negative NANB hepatitis. The long-term persistence of anti-HCV antibodies did not correlate with chronic evolution of liver infection in thalassaemic patients. Histological features of chronic hepatitis showed little or no difference between HCV associated or non-associated liver disease. The multifactorial liver injury in beta-thalassaemic children explains the high prevalence of cirrhosis (about 30%) observed in these patients with NANB hepatitis. On the other hand, independent of liver disease, some patients never seroconverted during the follow up in spite of the high number of transfusions suggesting the existence of "non-responders".

Chronic hepatitis in kidney allograft recipients

98 HBsAg-positive and 31 HBsAg-negative kidney recipients were compared to assess the effect of renal transplantation on chronic liver disease and vice versa. Diagnosis was based on analysis of liver biopsy specimens including semiquantitative evaluation of histological features of chronic hepatitis. Serial specimens were examined: chronic liver disease occurred in 88% of HBsAg-positive patients and 4% of HBsAg-negative patients with normal liver at the time of transplantation. Liver abnormalities in the former were chronic persistent hepatitis (32%), chronic active hepatitis (51%), and cirrhosis (17%). Actuarial patient survival was similar in HBsAg-positive (78%) and HBsAg-negative (87%) patients, as was allograft survival (64% and 71%, respectively). In both HBsAg-positive and HBsAg-negative patients chronic alcohol consumption was more frequent in those with chronic liver disease than those without. These data suggest that renal transplantation may be appropriate for haemodialysis patients with chronic hepatitis whatever their HBV status.

Recombinant human α-interferon: A promissory note in non-A, non-B chronic hepatitis

Therapy capable of ameliorating the clinical, laboratory, and histologic features of chronic hepatitis due to the non-A, non-B hepatitis viruses is not available. In the present experience, 10 patients with chronic fatigue, elevations of Serum aminotransferase levels for at least 1 yr, and liver biopsy results consistent with chronic non-A, non-B hepatitis were selected to be participants in this drug protocol. Nine of the 10 patients had a history of recognized percutaneous exposure to blood or parenteral drugs. Serum direct bilirubin was normal in all, and serum albumin and prothrombin time were normal in 9 of the 10. Nine of the 10 had chronic active hepatitis on initial liver biopsy and 3 of the 9 had accompanying cirrhosis. The 10th patient had chronic persistent hepatitis. All 10 were treated with self-administered, subcutaneous injections of recombinant huinan a-interferon [initially daily, then on alternate days or three times weekly) in daily doses varying between 5 and 1 million uaits. Subsequent reductions in doses were based on aminotransferase levels and side effects. Neither a placebo control group nor a cross-over schedule was utilized and no measures of compliance were described. In 8 of the 10 patients serum aminotransferase levels fell during treattnent, and in 6 of these patients the aminotransferase levels fell into the normal range. Treatment periods varied between 2 and 12 mo. In contrast, in 2 patients no beneficial effect of recombinant human ainterferon was observed. Of the 6 patients in whom aminotransferase levels returned to normal, 2 experienced a recurrence of elevated serum aminotransferase levels after discontinuation of the drug. Retreatment was associated with a decline into the normal range. Only 3 patients, in whom treatment was continued for 12 mo, underwent repeat biopsy. In each, evidence of histologic improvement was found. Side effect’s of treatment appeared to include fatigue, achiness, headaches, irritability, and fever but apparently in no case was treatment discontinued because of adverse effects. Whether or not the chronic fatigue or other symptoms seen in these patients were altered by treatment is uncertain as clinical improvement is not mentioned.

Inefficacy of Immunosuppressive Treatment in HBsAg‐Positive, †‐Negative, Moderate Chronic Active Hepatitis in Children

The efficacy of immunosuppressive treatment was evaluated in a group of 15 children (aged 2–10 years) affected by clinically asymptomatic, biochemically mild, HBsAg‐positive, †‐antibody‐negative, histologically moderate, chronic active hepatitis (CAH). Clinical, biochemical, serological, and histological features of chronic hepatitis B virus (HBV) infection were studied during a follow‐up of 2 years. Eight of 15 patients received immunosuppressive treatment (prednisone plus azathio‐prine); seven received a placebo. No significant differences were found among treated and untreated patients, an overall improvement of nearly all parameters of disease (aminotransferases, albumin, prothrombin time, immunoglobulins, bromsulphalein at 45 min, and bile acid serum levels) being found in both groups. Treated patients showed an improvement in aminotransferase levels only at the first 3‐month checkup. This finding, however, was not statistically significant in our study and disappeared at subsequent follow‐up examinations. A high incidence of HBeAg was noted at entry into the study (10 of 15 patients checked). HBeAg seroconversion was observed in two of the six HBeAg‐positive treated patients and in two of the four HBeAg‐positive untreated patients. Finally, the histological picture showed similar patterns in both groups of patients studied. Our data suggest that no benefit from immunosuppressive therapy can be proven at this time in asymptomatic, moderately active, HBsAg‐positive, †‐negative CAH in children.

Non-A, Non-B Hepatitis-Reply

In Reply .—In our previous study 1 we reported cases of childhood leukemia that were diagnosed 15 to 18 years ago and treated with inadequate therapeutic protocols. A good treatment can modify the role of some factors that possibly influence leukemia prognosis; in fact, we actually have not seen a different outcome in children with or without viral hepatitis. The liver immunofluorescence pattern that we have observed in patients with the NANB antigen has been the typical viral infection—linked one and has not been related to histologic severity. We are now investigating the presence of the delta antigen in these biopsy specimens, but we only have preliminary results. The HBV infection is associated with histologic features of chronic hepatitis and with long-lasting biochemical evidence of liver disease after cessation of therapy. 2,3 With regard to NANB hepatitis, data are too scant to define the long-term outcome. Anyway, only a sixth