Roger P M, Mondain V, St Paul M C, Peyrade F, Pesce A, Fuzibet J G, Michiels J F, Dellamonica P
Service des Maladies infectieuses et tropicales, Hôpital de l'Archet I, Nice.
Presse Med. 1998 Oct 24;27(32):1617-20.
There is substantial evidence demonstrating the aggravating effect of human immunodeficiency virus (HIV) infection on the progression of chronic hepatitis C virus (HCV) infection. There is however, little data on the affect of certain factors which could affect liver pathology findings in patients with concomitant HIV infection such as the duration of HIV infection or T-cell subpopulation counts. We examined pathology findings in patients with concomitant HIV and HCV infections to determine the impact of immunodepression.
We reviewed liver pathology data collected in patients with concomitant HIV and HCV infections grouping patients according to severity of the liver pathology: group 1 = cirrhosis or active hepatitis; group 2 = minimally active hepatitis or histologically normal liver. Transparietal liver biopsies were obtained for the work-up of viral hepatitis or because of long-term unexplained fever or suspected lymphoma. Epidemiological and biological data were obtained from medical files. The duration of the liver disease was estimated from the date of exposure to risk of immunodepression as determined by the peripheral CD4+ and CD8+ counts. All pathology specimens were read by two pathologists who established the Knodell score for each patient.
Fifty patients were included: 23 were classed in group 1 and 28 in group 2. The Knodell score was significantly different between the two groups, 11 +/- 4 and 4 +/- 3 respectively (p < 0.0001). Disease duration was similar for the two groups: mean 8 years. Mean CD4+ count was significantly higher in group 1: 312/mm3 versus 110/mm3 for group 2 (p = 0.0057); as was the mean CD8+ count (758/mm3 versus 360/mm3, p = 0.0013). For the entire study population, there was a significantly negative correlation (p < 0.05) between the Knodell score and the CD4+ count (r = 0.31) and for the CD8+ count (r = 0.41).
HCV-related liver pathology in patients co-infected with HIV depends on the level of immunodepression. CD8+ counts are better correlated with pathology findings than with CD4+ counts.
有大量证据表明人类免疫缺陷病毒（HIV）感染会加重慢性丙型肝炎病毒（HCV）感染的进展。然而，关于某些可能影响合并HIV感染患者肝脏病理结果的因素，如HIV感染持续时间或T细胞亚群计数的数据却很少。我们检查了合并HIV和HCV感染患者的病理结果，以确定免疫抑制的影响。
我们回顾了合并HIV和HCV感染患者的肝脏病理数据，根据肝脏病理严重程度对患者进行分组：第1组 = 肝硬化或活动性肝炎；第2组 = 轻度活动性肝炎或组织学正常肝脏。经皮肝穿刺活检用于病毒性肝炎的检查，或因长期不明原因发热或疑似淋巴瘤而进行。从医疗档案中获取流行病学和生物学数据。根据外周血CD4 + 和CD8 + 计数确定的免疫抑制风险暴露日期来估计肝病持续时间。所有病理标本由两位病理学家阅片，他们为每位患者确定Knodell评分。
纳入50例患者：23例归入第1组，28例归入第2组。两组的Knodell评分有显著差异，分别为11±4和4±3（p < 0.0001）。两组的疾病持续时间相似：平均8年。第1组的平均CD4 + 计数显著更高：312/mm³，而第2组为110/mm³（p = 0.0057）；平均CD8 + 计数也是如此（758/mm³ 对360/mm³，p = 0.0013）。对于整个研究人群，Knodell评分与CD4 + 计数（r = 0.31）和CD8 + 计数（r = 0.41）之间存在显著负相关（p < 0.05）。
合并HIV感染患者的HCV相关肝脏病理取决于免疫抑制水平。CD8 + 计数与病理结果的相关性比CD4 + 计数更好。
