The influence of hepatitis B and C virus coinfection on liver histopathology in children

Abstract

The influence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on liver histology in children remains unknown. We analyzed histopathological features in 70 treatment-naïve children: 10 with HBV/HCV coinfection (case group A), 30 with HBV (control group B), and 30 with HCV (control group C). Liver biopsies were scored for grading and staging according to Knodell's modified system and were tested for an association with demographic and laboratory data. The mean grade was higher in coinfected children compared to control group C (6.2 ± 3.0 vs. 4.2 ± 2.5, p = 0.04), but not control group B (p = 0.47). A higher proportion of patients with moderate to severe necroinflammation were observed in case group A compared to isolated HCV (p = 0.05). Mean staging did not differ between the case and control groups. Multivariate analysis revealed that HBV/HCV coinfection and aminotransferase activity were independently associated with moderate to severe necroinflammatory activity Conclusion: HBV/HCV coinfection was associated with moderate to severe necroinflammation irrespective of age at biopsy or duration of infection and led to significantly higher necroinflammatory activity than HCV monoinfection. HBV/HCV coinfection did not enhance fibrosis. High aminotransferase levels were positively associated with moderate to severe necroinflammation.

Fig. 1

Flowchart of patient selection

Fig. 2

Mean grading in case group HBV/HCV compared to monoinfection control groups. Error bars indicate standard deviations

Fig. 3

Aminotransferase levels based on necroinflammation grades: 1 (minimal, 0–3 points), 2 (mild, 4–8), 3 (moderate, 9–12), and 4 (severe, 13–18). a ALT versus grading. Kruskal-Wallis test p = 0.0003. b AST versus grading. Kruskal-Wallis test p = 0.005