Histologic distribution of hepatitis A, B, C, D, E, and G with concomitant cytokine response in liver tissue

The purpose of this study was to determine the frequency of infection by hepatitis A, B, C, D, E, and G in liver biopsy specimens from symptomatic patients and to correlate viral localization with the expression of interferon 7, interleukin 4, and tumor necrosis factor messenger RNA. Tissue biopsy specimens were taken from 78 patients as follows: 14 patients with transplants, 23 patients with cirrhotic livers, and 41 patients with chronic hepatitis. At least one of the hepatitis viruses was detected in 60 of 78 (77%) specimens; multiple infection was evident in 18 of 78 (23%) specimens. The overall incidence of the different viruses was as follows: 8% hepatitis A, 3% hepatitis B, 52% hepatitis C, 1% hepatitis D, 24% hepatitis E, 18% hepatitis G. Throughout each category, hepatitis C was the most common virus detected. No histologic variable correlated with either the percentage of infected hepatocytes per lobule or nodule or with the specific viral type. The cytokines localized to monocytes or lymphocytes adjacent to infected hepatocytes. These results demonstrate that viral infection is present in most biopsy specimens of patients with chronic hepatitis and liver transplants and that hepatitis C, E, and G account for most of the infections. The results also suggest that direct viral infection in conjunction with expression of different cytokines is important in the pathophysiology of viral-induced liver disease.