Histomorphological changes in hepatitis C non-responders with respect to viral genotypes.

OBJECTIVE To evaluate the distinct histopathological changes of chronic hepatitis C (CHC) non-responders in association with viral genotypes. METHODS This cross-sectional study was conducted at the histopathology section of the Dow Diagnostic Research and Reference Laboratory, Dow University of Health Sciences in collaboration with Sarwar Zuberi Liver Centre, Civil Hospital, Karachi from September 2009 to August 2011. Seventy-five non-responders (end-treatment-response [ETR] positive patients) from a consecutive series of viral-RNA positive CHC patients with known genotypes were selected. Their genotypes and pertinent clinical history was recorded. They were subjected to liver biopsies which were assessed for grade, stage, steatosis, stainable iron and characteristic histological lesions. RESULTS Majority of the patients (63, 84%) had genotype 3 while 12(16%) cases had genotype 1. The genotype 1 patients had significantly higher scores of inflammation (p < 0.03) and fibrosis (p < 0.04) as compared to genotype 3. Steatosis was significantly present in all genotype 3 patients in higher scores (p < 0.001) compared to genotype 1. Stainable iron scores were generally low in the patients in this study, however, it was more commonly seen in genotype 3.The distribution of characteristic histological lesions was noteworthy in both the groups, irrespective of genotype. CONCLUSION In this series, the predominant genotype was 3. However, genotype 1 patients were more prone to the aggressive nature of the disease with significantly higher scores of inflammation and fibrosis. Steatosis was characteristically observed in genotype 3 group. Stainable iron could not be attributed as a cause of non-response.