**5. Conclusion**

ble 8, samples of biopsies № 4 and № 5). As a rule the ferment activity rather reduced under the fibrosis intensification. The AST/ALT ratio was increased in 3 patients. In other cases it

We have not discovered any direct interconnections between the ferment activity levels and the sizes of the specific parts of intralobular necroses. The intralobular piecemeal necroses were dominant in this group of the patients; perhaps, the hepatocytes destruction was

Detailed information about natural history of HIV/HCV co-infection is discussed in special review article [27]. Some studies have suggested that human immunodeficiency infection modifies the natural history of hepatitis C virus infection accelerating the progression of fib‐

Co-infection HCV/HIV is very often discovered among injecting drug users [32, 33]. Thus, it was shown that about 90% drug users (consumers of heroin) are infected by hepatitis C vi‐ rus [34]. Intravenous heroin abuse induces significant morphological changes in liver tissue (vesicular changes, fatty changes, chronic hepatitis, cirrhosis), and the severity of these changes increases with years of heroin abuse [35]. Authors supposed that worsening of mor‐ phological changes in the liver happens mostly often because of a significantly reduced de‐

Espinal, Peréz, Baéz, Hénriguez et al. [36] analyzed the clinical aspects of the co-infection HIV and tuberculosis. Tuberculosis remains an important public health problem in the world that has been exacerbated by HIV epidemic, resulting in increased morbidity and mortality [37, 38]. The pathogenesis and mechanisms of inflammation and accelerated fibro‐

At present investigation the peculiarities of patients with heroin abuse and co-infection (TB, HCV and HIV) were analyzed (see Table 1). All the patients were males of the age from 26 to 39 years (mean value was 32.2 years). The heroin abuse was the longest (mean value was 13.6 years). Patients with HCV-infection occupied the second position of disease duration (mean value was 7.1 years), than there were the patients with HIV-infection (mean value was 4.7 years) and finally the patients with TB-infection (mean value was 3.5 years). At last case the tuberculosis was discovered for the first time of 7 patients from 13 patients. It is characteristic that *Mycobacterium tuberculosis* was not discovered in phlegm of any patients

We could not detect any interconnections between the quantitative parameters of biopsy specimen getting with the use of computer microscopy and for the duration of above-men‐

Moreover the tendency to the diseases heaviness increasing is evident. The good example of this tendency is the biopsy specimen № 9: the duration of heroin abuse in this case com‐

was closer to the upper border of the normal level.

250 Liver Biopsy - Indications, Procedures, Results

rosis and the development of cirrhosis [28, 29, 30, 31].

sis in co-infected patients are still poorly understood [28, 39].

toxification functions of the liver.

under repeated analyses.

tioned observations.

**4. Discussion**

caused by the special mechanism of the cell death (apoptosis).

Morphometric image analysis gives a possibility to evaluate quantitative parameters of nec‐ ro-inflammatory and fibrosis changes in liver biopsy of patients with mixed infections and heroin abuse.

It is characteristic that the combination of different infections leads to the progression of liv‐ er inflammation and the increasing of the portion of non-parenchymal elements as a total sum of portal areas, intralobular infiltrates and distended hepatic vessels.

The investigation showed significant intensification of necroinflammatory lesions. Lympho‐ histiocyte infiltration was typical both for portal zones and intralobular areas. These mor‐ phological indications could be connected with the change of the immune state of patients as a result of combine effect of bacterial, viral infections and heroin abuse. So, numerous fac‐ tors have been associated with an increased risk of fibrosis progression in liver of such type of patients.

Of course, it is necessary for more correct analysis to study the biopsies of the patients of several control groups with the sequential cut-off of the definite factors. We plan to carry out such investigation in future.

J., Morishima, C., & the HALT-C Trial Group. (2009). Fibrosis Progression in Chronic Hepatitis C: Morphometric Image Analysis in the HALT-C Trial. *Hepatology*, 50(6),

Computer Image Analysis of Liver Biopsy Specimens in Patients with Heroin Abuse and Coinfection ...

http://dx.doi.org/10.5772/52971

253

[8] Filimonova, G., Tokin, I. I., Tokin, I. B., & Hussar, P. (2010). An Assessment of Mor‐ phometric Analysis in Liver Biopsy Specimens with Chronic Hepatitis C. *Papers on*

[9] Tokin, I. B., Tokin, I. I., & Filimonova, G. F. (2011). Quantitative Morphometric Anal‐ ysis of Liver Biopsy: Problems and Perspectives. *In: Liver Biopsy. Ed. By Hirokazu Ta‐*

[10] Kage, M., Shimamatu, K., Nakashima, E., Kojiro, M., Inoue, O., & Yano, M. (1997). Long-Term Evolution of Fibrosis from Chronic Hepatitis to Cirrhosis in Patients with Hepatitis C: Morphometric Analysis of Repeated Biopsies. Hepatology April , 25(4),

[11] Manabe, N., Chevallier, M., Chossegross, P., Causse, X., Guerret, S., & Trepo, Gri‐ maud. G. (1993). Interferon-alfa 2b Therapy Reduces Liver Fibrosis in Cronic A, Non-B Hepatitis: A Quantitative Histological Evaluation. *Hepatology,* December , 18(6),

[12] Duchatelle, V., Marcellin, P., Giostra, E., Bregeaud, L., Pouteau, M., Boyer, N., Auper‐ in, A., Guerret, S., Erlinger, S., Henin, D., & Degott, C. (1998). Changes in Liver Fibro‐ sis at the End of Alfa Interferon Therapy and 6 to 18 Months Later in Patients with Chronic Hepatitis C: Quantitative Assessment by a Morphometric Method. *Journal of*

[13] Caballero, T., Pérez-Milena, A., Masserolli, M., O`, Valle. F., Salmerón, F., Del Moral, R., & Sánches-Salgado, G. (2001). Liver Fibrosis Assessment with Semiquantitative Indexes and Image Analysis Quantification in Sustained-Responder and Non-Res‐ ponder Interferon-treated Patients with Chronic Hepatitis C. *Journal of Hepatology*,

[14] Benhamou, Y., Di Martino, V., Bochet, M., Colombet, G., Thibault, V., Liou, F., Katla‐ ma, K., Poynard, T., & and for the Multivir C Group. (2001). Factors Affecting Liver Fibrosis in Human Immunodeficiency Virus and Hepatitis C Virus Co-infected Pa‐ tients: Impact of Protease Inhibitor Therapy. *Hepatology*, 34(2), August, 283-287.

[15] Martinez-Sierra, C., Arizcorreta, A., Diaz, F., Roldán, R., Martin-Herrera, L., Pérez-Guzmán, E., & Girón-González, J. (2003). Progression of Chronic Hepatitis C to Liver Fibrosis and Cirrhosis in Patients Coinfected with Hepatitis C Virus and Immunode‐

[16] Poynard, T., Mathurin, P., Ching-Lung, Lai., Quyader, D., Poupon, R., Tainturier, M. H., Myers, R., Muntenau, M., Ratziu, V., Manns, M., Arndt, V., Capron, F., Chedid, A., & Bedossa, P. (2003). for the Panfibrosis Group. (A Comparison of Fibrosis Pro‐

gression in Chronic Liver Diseases. *Journal of Hepatology*, 38(3), 257-265.

ficiency Virus. *Clinical Infectious Diseases*, 36(2), 491-498.

1738-1749.

1028-1031.

1344-1349.

*Hepatology*, 29(1), 20-28.

34(1), 740-747.

*Anthropology. Tartu, Estonia*, XIX, 69-80.

*kahashi, INTECHWEB.ORG*, 137-154.

Quantitative analysis of digital images of total biopsies is indispensable to study the effec‐ tiveness of treatment tactics testing as the effect of therapy can be calculated as the percent‐ age of morphological changes in biopsy.
