Leptin Enhances Pdgf-Dependent Cell Growth In Hepatic Stellate Cells: Involvement Of The Pi3k-Akt Pathway

Diftet~mces in HCN' between C and AA remain controversial.Previous studies have been limited by size and heterogeneity of the populations studied Although HCV is common in fbe DOC, the spectrum of liver disease in this setting has not been well characterized and ofters a unique opportunity to compare the spectrum of liver disease between C and AA in a relatively homogeneous population.AIM: To describe the biochemical, virologic, and histologic spectrum of HCV in the DO(; METHODS: A retrospective analysis of cot~secutive inmates biopsied for chronic HCV bev,veen 10/98 and 7/02 was performed.All patients included were anti-HCV +, hqd a platdet count > 70,000, an INR < 1.4, and no evidence of hepatic decompensation Patients were excluded I]'om anab, sis if they were HI"/ +, HBV SAg -~, had evidence of other liver disease, or creatinine > 2.0 mg/dL HCV RNA and genotyping (GT) were obtained at time of biopsy" and liver histology' assessed by Knodell histulogic activity index (HAD with histologically-significant disease defined as total HAI> 4 or any degree of fibrosia and advanced disease as presence ot bridging fibrosis (BF) or cirrhosis (Cx), RESUhTS: 302 inmates meeting criteria were analyzed.The mean age was 41, 91% were male, and 51% C The mean ALT was 94 U/I and 49% had a normal ALT at the time of biopsy,.HCV RNA was + in all tested and 80% were GT i.The total HAI was 7,03: 85% had stgniticant hepatitis and 24% had advanced tibrosis When stratified by race, AA were more lfkely GT 1 (94% vs 67%; pC.001) and have lower ALT (79 U/1 vs 106 U/I; p = .01)with simdar overall HAI (6.99 vs 7.59; p = .09)compared to C. While AA had slightly lower fibrusis scores (1.12 vs 1.40; p= .047),there were no differences in % advanced tibrosis (22 vs 28).Those with mild disease (HAl < 5) had lower ALT values (68 U/I vs 98 U/k pC.001) and higher % with normal ALT (70 vs 46; p= .004)compared to those with significant disease.The sensitivity, specificity, positive and negative predictive values toe a normal ALF to predict mild disease were 70%, 53%, 22% and 90% and for an elevated ALT to predict signiticant histology were 90%, 21%, 53%, and 69%, respectively.CONCLUSIONS: Sigraficant hepatitis is seen in the malority oI inmates with HCV and 24% have advanced fibrosis.[here were no clinically significant differences between C and AA.Because ALl" had poor accuracy, liver biopsy ia essential to idemify those with significant or advanced histupathology that might benebt from anti-HCV therapy, 253