Bierhoff E, Fischer H P, Willsch E, Rockstroh J, Spengler U, Brackmann H H, Oldenburg J
Department of Pathology, University of Bonn, Germany.
Virchows Arch. 1997 Apr;430(4):271-7. doi: 10.1007/BF01092749.
To investigate the influence of human immunodeficiency virus (HIV) coinfection on preexisting long-term chronic C hepatitis (HCV) 68 liver biopsies from 22 HIV/HCV-coinfected, 13 HIV- and 33 HCV-monoinfected patients and 71 livers obtained at autopsy from 26 HIV/HCV-coinfected and 45 HIV-monoinfected patients were studied by histo- and immunohistochemistry. All HIV patients had reached the advanced stage of immunodeficiency (stage III CDC), except for 3 haemophilias (stage II CDC). HCV infection was associated with a higher degree of portal, periportal and lobular inflammation-regardless of whether there was concurrent HIV infection. HIV/HCV coinfection was associated with a significantly higher rate of granulocytic cholangiolitis than HCV and HIV monoinfection (P < 0.05), a histological feature uncommon in C hepatitis. In HIV/HCV coinfection cholestasis was a predominant histological feature. HCV monoinfection and HCV/HIV coinfection were associated with the highest fibrosis index. In HIV/HCV coinfection centrilobular fibrosis was significantly more marked than in HCV monoinfection (P < 0.05), suggesting an HIV-associated fibrogenic effect. Patients with chronic C hepatitis showed a significantly increased rate of posthepatitic cirrhosis compared with the patients without HCV infection (P < 0.05). At autopsy, 10 of the 20 HIV/HCV-coinfected haemophiliacs had developed cirrhosis because of chronic C hepatitis, whereas cirrhosis was found in only 2 of 6 HIV/HCV-coinfected non-haemophiliacs (1 case of chronic B and C hepatitis, and 1 case of chronic alcohol abuse). No cirrhosis was observed in the 45 autopsy patients with HIV monoinfection. The findings suggest that HIV coinfection aggravates the course of preceding long-term chronic C hepatitis by a more marked (centrilobular) fibrosis. HIV/HCV-coinfected patients are threatened by a higher rate of posthepatitic cirrhosis-particularly in multitransfused haemophiliacs-and cholestatic hepatopathy.
为研究人类免疫缺陷病毒（HIV）合并感染对先前已存在的慢性丙型肝炎（HCV）的影响，我们对22例HIV/HCV合并感染、13例HIV单感染和33例HCV单感染患者的68份肝活检组织，以及26例HIV/HCV合并感染和45例HIV单感染患者尸检获得的71份肝脏组织进行了组织学和免疫组织化学研究。除3例血友病患者（疾病控制中心[CDC]II期）外，所有HIV患者均已处于免疫缺陷晚期（CDC III期）。无论是否合并HIV感染，HCV感染均与门管区、汇管区周围和小叶炎症程度较高相关。与HCV和HIV单感染相比，HIV/HCV合并感染患者的粒细胞性胆管炎发生率显著更高（P<0.05），这是丙型肝炎中不常见的组织学特征。在HIV/HCV合并感染中，胆汁淤积是主要的组织学特征。HCV单感染和HCV/HIV合并感染与最高的纤维化指数相关。在HIV/HCV合并感染中，小叶中央纤维化比HCV单感染明显更显著（P<0.05），提示存在与HIV相关的纤维化作用。与未感染HCV的患者相比，慢性丙型肝炎患者肝炎后肝硬化的发生率显著增加（P<0.05）。尸检时，20例HIV/HCV合并感染的血友病患者中有10例因慢性丙型肝炎发展为肝硬化，而6例HIV/HCV合并感染的非血友病患者中只有2例发现肝硬化（1例慢性乙型和丙型肝炎，1例慢性酒精滥用）。45例HIV单感染的尸检患者中未观察到肝硬化。这些发现表明，HIV合并感染通过更显著的（小叶中央）纤维化加重了先前长期慢性丙型肝炎的病程。HIV/HCV合并感染患者受到更高的肝炎后肝硬化发生率的威胁，尤其是在多次输血的血友病患者中，以及胆汁淤积性肝病。
