Histopathological Grading and Staging of Chronic Hepatitis C Patients in Rural Sindh

OBJECTIVE: To determine the grading and staging of chronic hepatitis induced by hepatitis C virus in rural Sindh. DESIGN: A prospective, observational study. SETTING: Medical Research Center Liaquat University of Medical and Health Sciences Jamshoro, Department of Pathology, Nawabshah Medical College for Girls Nawabshah and Biotechnology Department of University of Karachi, from August 2006 to June 2008. PATIENTS: A total of 344 HCV-PCR positive patients were selected by non-probability convenient sampling technique. (Overall 239 men and 105 women with age 18–55 years included in the study.) METHODOLOGY: All the patients went for ELISA test for the presence of HCV antibodies by ELISA kit of Biokit Spain and HCV-RNA by RT-PCR on Cephid smart cycler, and then a hepatic biopsy was performed in clinically indicated patients and the biopsy fragments were submitted to conventional histopathological procedures. RESULTS: According to histopathological analysis of 344 biopsy samples of chronic hepatitis C patients 38 (11.04%) patients presented with necro-inflammatory grade 1, 151 (43.89%) with grade 2, 117 (34.01%) with grade 3 and 38 (11.04%) cases presented with grade 4; while no biopsy specimen revealed necro-inflammatory grade 0. Majority of patients presented with fibrosis grade 2 and fibrosis grade 1 in 121 (35.17%) and 102 (29.65%) biopsy samples respectively followed by fibrosis grade 3 in 77 (22.38%), fibrosis grade 4 in 30 (8.72%) and fibrosis grade 0 in 14 (40.6%) cases. CONCLUSION: In current study we observed majority of cases in A2, A3 grade of inflammation and F1, F2, F3 stages of fibrosis, which indicates that patients came late for medical assessment which may cause difficulties in management. This warrants the necessity of HCV awareness programs in rural areas of Sindh.