Epidemiological factors in relation to histopathology of chronic hepatitis C infection

ABSTRACT

This study was designed to find the relation between the histopathological features of chronic hepatitis C infection and epidemiological factors. We reviewed the records of three hundred patients from Bristol Royal Infirmary, Bristol, UK. The mean age of the patients was 42.5 +/- 10.6 years. 205 patients [68.3%] were males and 95 [31.7%] were females. The mean duration of infection was 15.1 +/- 8.3 years. The most frequent risk factor was IVDU. 62.7% of the patients were asymptomatic and 73.7% had no clinical signs of chronic liver disease. All patients were positive for hepatitis C antibody and PCR. Histopathological grading and staging [modified Ishak HAI] were normal liver in 3 cases [1%], minimal chronic hepatitis in 50 cases [16.8%], mild chronic hepatitis in 159 cases [53.5%], moderate chronic hepatitis in 81 cases [27.3%] and severe chronic hepatitis in 4 cases [1.3%]. Three cases [1%] were hepatocellular carcinoma. There was no significant gender difference in respect of grade or stage of chronic hepatitis C infection [P>0.05]. Patients less than 40 years old and those with duration of infection less than 20 years were more frequent in Stages 1 and 2 while patients aged 40 and above and those with duration of infection of 20 years and above were more frequent in stages 5 and 6 fibrosis [P<0.001]. Other histological features also present included steatosis in 68 cases [22.9%], lymphoid follicles / aggregates in 27 cases [9.1%] and bile duct proliferation in 17 cases [5.7%]. These 3 features were more often encountered in mild chronic hepatitis. However bile duct proliferation was more common among patients with cirrhosis. We conclude that more than half of chronic hepatitis C patients presented with mild histological features. The duration of infection and the patient's age were associated with liver fibrosis. Steatosis, lymphoid follicles and bile duct proliferation were present in association with chronic hepatitis C in a proportion of cases