Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.
Am J Clin Pathol. 2019 Nov 4;152(6):735-741. doi: 10.1093/ajcp/aqz095.
To evaluate histologic changes occurring in patients having chronic hepatitis C and autoimmune hepatitis overlap (HCV-AIH), and who achieved virologic cure using direct-acting antiviral agents (DAA).
Characteristics of HCV-AIH patients who underwent paired liver biopsies before and after receiving DAA treatment from 2011 to 2018 were evaluated.
Five HCV-AIH patients (three male; mean age, 60.4 years) underwent paired liver biopsies (average interval, 2.3 years) before and after achieving cure with DAA treatment. All patients showed virologic response, while four showed decreased inflammation, and three cases showed features of fibrosis regression. Immunohistochemical staining demonstrated significant decrease in plasma cell count in three patients (20.6 vs 11.9 plasma cells/high power field; P = .02, t test).
Histologic improvements in inflammation and fibrosis are noted in most HCV-AIH patients after DAA treatment, suggesting that the autoimmune component of the HCV-AIH overlap syndrome is merely a secondary phenomenon of viral infection.
评估慢性丙型肝炎和自身免疫性肝炎重叠（HCV-AIH）患者在接受直接作用抗病毒药物（DAA）治疗实现病毒学治愈后发生的组织学变化。
评估了 2011 年至 2018 年间接受 DAA 治疗的 HCV-AIH 患者的配对肝活检特征。
5 例 HCV-AIH 患者（3 例男性；平均年龄 60.4 岁）在接受 DAA 治疗实现病毒学应答后进行了配对肝活检（平均间隔 2.3 年）。所有患者均表现出病毒学应答，而 4 例炎症减轻，3 例纤维化程度降低。免疫组化染色显示 3 例患者的浆细胞计数显著减少（20.6 与 11.9 个浆细胞/高倍视野；P =.02，t 检验）。
在 DAA 治疗后，大多数 HCV-AIH 患者的炎症和纤维化组织学改善，表明 HCV-AIH 重叠综合征的自身免疫成分仅是病毒感染的继发现象。
