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abstract 223. FIBROSIS (F) AND HISTOLOGICAL ACTIVITY INDEX (HAI) IMPROVE SPONTANEOUSLY IN UNTREATED, NONCIRRHOTIC, PERSISTENTLY VIREMIC IRISH WOMEN WITH CHRONIC HEPATITIS C.
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Robert A Levine, Schuyler O Sanderson, SUNY Upstate Med Univ, Syracuse, NY; Frank Murray, Dermot Manning, Beaumont Hosp, Dublin Ireland; John Hegarty, Niamh Nolan, St Vincent's Hosp, Dublin Ireland; Dermot Kelleher, George McDonald, St James's Hosp, Dublin Ireland; J C O'Keane, John Crowe, Mater Misericordiae Hosp, Dublin Ireland
Background: We previously documented that 20% of 49 Irish women who acquired hepatitis C genotype 1b infection via anti-immunoglobulin in 1977 improved their Knodell/IASLD HAI scores (Levine, R.A., et al, Gastroenterology 2000; 118, A944). ALT concomitantly decreased significantly. Confounding variables, including alcohol, were absent. To confirm these results, we evaluated 154 additional liver biopsies (bxs).
Methods: Strict qualifying bx criteria were size > 1.0 cm, portal areas > 3, HAI/F unchanged = -1 to 1+ points, improved = -2/-1 points, worse = +2/+1 points, respectively. All paired bxs were evaluated blindly by the same pathologist with a second pathologist.
Results: Overall, HAI scores decreased significantly during a mean interval of 3.6 yrs (range 1-8, TABLE). Both HAI/F decreased significantly in 27%/28% of patients; increased in 18%/25%, and were unchanged in 55%/47%, respectively. Cirrhosis was absent. Mean (and maximum) HAI/F scores for improved and worse cohorts were -2.9 (-6) and +2.3 (+4); and -1.2 (-3) and +1.2 (+3), respectively. In the improved cohort, baseline bx HAI/F scores were elevated significantly (p < 0.05, ANOVA), compared to unchanged or worse cohorts, and in their final bxs HAI/F was significantly less than in the worse cohort, and HAI less than in the unchanged cohort. There was interobserver HAI/F score agreement between pathologists. When changes in HAI were compared to respective F scores in all cohorts, there was good concordance (Pearson correlation r = 0.52, p < 0.001). Bx sampling error appeared unlikely, since sequential bxs showed minimal variability and the same trending as the total group: Mean HAI/F in patients with 3 bxs (n = 32): #1 = 5.3/1.9, #2 = 5.3/2.1, #3 = 5.0/2.2; 4 bxs (n = 7): #1 = 6.8/3.0, #2 = 6.5/2.9, #3 = 6.6/3.0, #4 = 5.7/2.4. Confounding variables (alcohol, herbal and paracetamol use) are under study.
Conclusions: After approximately 24 yrs, HAI decreased significantly in viremic women. HAI/F scores were significantly reduced in 27%/28% of patients (improved cohort), increased in 18%/25% (worse cohort), and unchanged in 55%/47%, respectively. The improved cohort comprised those with the most elevated HAI/F scores initially, compared to unchanged and worse cohorts, and their final bxs had the lowest HAI scores.
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