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Hepatic giant cells in hepatitis C virus (HCV) mono-infection and HCV/HIV co-infection
  1. S T L Micchelli1,
  2. D Thomas2,
  3. J K Boitnott1,
  4. M Torbenson1
  1. 1Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Dr M Torbenson, Room B314, 1503 East Jefferson, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; mtorben{at}


Background: The clinical and biological significance of syncytial giant cell change of hepatocytes in hepatitis C viral (HCV) infection is poorly understood.

Aim: To investigate the clinical and histological correlates of giant cell transformation in the setting of HCV mono-infection and co-infection with HCV and HIV.

Methods: The prevalence of hepatocyte giant cell transformation was determined and serological, biochemical and histological findings examined.

Results: Among 856 liver biopsy specimens, 22 cases (2.6%) showed giant cell transformation, representing 18 individuals. The median serum ALT was 37 IU/l, AST 49 IU/l, and alkaline phosphatase 97 IU/l. Eleven cases had HCV RNA loads available, with a median HCV RNA of 5.52 log IU/ml. Twelve of 17 individuals with available test results were also HIV positive (71%), compared to 46% of controls (p = 0.08). Giant cell transformation was found exclusively in zone 3 hepatocytes; the accompanying histological findings were otherwise typical of chronic HCV. The hepatic giant cells typically had a cytoplasmic appearance that resembled smooth endoplasmic reticulum proliferation. Most cases had only mild inflammation and fibrosis, with a median modified hepatic activity index (MHAI) grade of 3/18 and a median MHAI stage of 1/6. Three individuals had follow-up biopsies; all continued to have giant cell change.

Conclusion: Giant cell transformation occurs most commonly in the setting of HCV/HIV co-infection, but can also be seen in chronic HCV infection alone. Histologically, giant cells were located in zone 3 hepatocytes, were persistent over time, and do not appear to be a marker of aggressive hepatitis.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was obtained.