Bronchoalveolar lavage fluid analysis in individuals with chronic hepatitis C

Abstract

A number of disorders for which an association with hepatitis C virus infection exist. These disorders include essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and idiopathic pulmonary fibrosis. This study was initiated to investigate the cellular content and lymphocyte subpopulations of bronchoalveolar lavage fluid obtained from individuals with chronic hepatitis C and to compare the results to those of controls. Eighteen patients with chronic hepatitis C (male/female, 6/12) and 14 healthy volunteers (male/female, 6/8), were studied. Bronchoalveolar lavage fluid was obtained from each; and the lymphocyte subtypes and the presence of HCV-RNA in the bronchoalveolar lavage fluid were determined. All anti-HCV positive subjects were HCV-RNA positive in serum. One (5.6%) had a HCV-RNA positive bronchoalveolar lavage. The total cell and neutrophil counts of the bronchoalveolar lavage fluid were significantly greater in patients with chronic hepatitis C as compared to controls (5,799.6 +/- 957.4 x 10(3)/ml vs. 1,835.7 +/- 447.8 x 10(3)/ml, P = 0.001; 1,175.8 +/- 634.7 x 10(3)/ml vs. 53.1 +/- 28.1 x 10(3)/ml, P = 0.029). In contrast, the lymphocyte, macrophage and eosinophil counts did not differ. No difference in the percentage, median or range of individual T cell subsets or B cell numbers in the bronchoalveolar lavage fluid existed between the groups. It is concluded that hepatitis C virus infection may be associated with an occult pulmonary inflammatory reaction manifested by an increased number of polymorphonuclear neutrophils in bronchoalveolar lavage fluid. This finding may contribute to the process that leads to idiopathic pulmonary fibrosis seen in a minority of cases of chronic hepatitis C.

An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management

“…However, negative association studies have also been reported (41,52). Variable results have emerged from studies of hepatitis C (30,36,37,39,42,47,49). Elevation of serum antibodies to cytomegalovirus has been reported (43), while associations with other viruses, including BK and JC polyomaviruses, have not been found (51).…”

“…Several studies have investigated the possible role of chronic viral infection in the etiology of IPF (30,(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). Most research has been focused on Epstein-Barr virus (EBV) (38, 40, 41, 44-46, 48, 50, 52) and hepatitis C (30,36,37,39,42,47,49). Both the protein and the DNA of EBV have been identified in lung tissue of patients with IPF, usually in the alveolar epithelial cells (38,44).…”

Hepatitis C Virus Infection Is Not An Independent Risk Factor For Obstructive Lung Disease

“…From a biological standpoint, HCV infection is recognized to trigger a chronic inflammatory response and HCV virus is detectable in the lung (8–10). Several epidemiological studies have suggested that HCV could be a risk factor for OLD (11–13).…”

Hepatitis C virus enhances incidence of idiopathic pulmonary fibrosis

“…Idilman et al [27] have reported that an increased bronchoalveolar lavage neutrophil count in individuals with HCV induced chronic active hepatitis was identified. This finding suggests that HCV may have the potential to induce an alveolitis leading to fibrotic changes in the lung.…”

“…Our results indicate that aging, liver cirrhosis and smoking enhance the development of IPF in patients with chronic hepatitis C infection. Idilman et al [27] have reported that HCV infection might be associated with an occult pulmonary inflammatory reaction manifested by an increased number of polymorphonuclear neutrophils in bronchoalveolar lavage fluid. Aging, liver cirrhosis, and smoking might enhance an occult pulmonary inflammatory reaction.…”