An Outbreak Presents An Opportunity to Learn About A Rare Phenotype: Autoimmune Hepatitis After Acute Hepatitis A

Are, Vijay S.; Yoder, Lindsay; Samala, Niharika; Nephew, Lauren; Lammert, Craig; Vuppalanchi, Raj

doi:10.1016/j.aohep.2020.08.069

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…In patients already burdened with chronic hepatopathies or cirrhosis, HAV over-infection can lead to a further deterioration, causing for example acute liver failure. Although no etiological association between HAV infection and liver failure has been identified, there after HAV should prompt concern for AIH, especially in cases with seroconversion to smooth muscle antibody positivity (19). Likewise, during post-HAV-treatment period, a recurrent increase of liver enzymes arises possibility of AIH development (27).…”

Section: Genetic Factors Potentially Involved In Havrelated Autoimmun...mentioning

confidence: 99%

“…Patients with acute HAV infection could also develop AIH (18,19) (Figure 1). In this respect, the HAVrelated tissue injury is mediated by an intense immune response, rather than a direct HAV-related toxicity, and an uncontrolled latent stimulation of host's defense could be the main mechanism.…”

Section: Hepatic Autoimmune Manifestations Linked To Hepatitis a Infe...mentioning

confidence: 99%

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Local and systemic autoimmune manifestations linked to hepatitis A infection

Doulberis,

Papaefthymiou,

Polyzos

et al. 2023

AGEB

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Hepatitis A virus (HAV) represents a global burdening infectious agent causing in the majority of cases a self-limiting acute icteric syndrome, the outcome is related to the hepatic substrate and the potential pre-existing damage, whereas a plethora of extra-hepatic manifestations has also been reported. Despite the absence of post- HAV chronicity it has been associated with an additional burden on existing chronic liver diseases. Moreover, the induced immune response and the antigenic molecular mimicry are considered as triggering factors of autoimmunity with regional and distal impact. Diseases such as autoimmune hepatitis, Guillain-Barré syndrome, rheumatoid arthritis, Still’s syndrome, Henoch-Schönlein purpura, autoimmune hemolytic anemia, antiphospholipid syndrome, systematic lupus erythematosus or cryoglobulinemic vasculitis have been described in patients with HAV infection. Although the exact mechanisms remain unclear, this review aims to accumulate and clarify the pathways related to this linkage.

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Section: Genetic Factors Potentially Involved In Havrelated Autoimmun...mentioning

confidence: 99%

Section: Hepatic Autoimmune Manifestations Linked To Hepatitis a Infe...mentioning

confidence: 99%

Local and systemic autoimmune manifestations linked to hepatitis A infection

Doulberis,

Papaefthymiou,

Polyzos

et al. 2023

AGEB

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“…Autoimmune hepatitis (AIH) was triggered by hepatitis A in 11 published cases[ 35 - 44 ]. In some of these patients, this was accompanied by the appearance of ANA.…”

Section: Hepatitis Amentioning

confidence: 99%

Immune disorders and rheumatologic manifestations of viral hepatitis

Maslennikov¹,

Ивашкин²,

Efremova³

et al. 2021

WJG

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Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders (the formation of cryoglobulins, rheumatoid factor, antinuclear antibodies, autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis, and others), which can manifest as glomerulonephritis, arthritis, uveitis, vasculitis (cryoglobulinemic vasculitis, polyarteritis nodosa, Henoch-Schonlein purpura, isolated cutaneous necrotizing vasculitis), and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs. The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C. Only isolated cases of these associations are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E, possibly due to their relatively rare diagnoses. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis, and if present, these patients should be treated with antiviral drugs.

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“…Nevertheless, the pathophysiological background of HAV-mediated tissue damage implies a potential indirect contribution to HCC, at least in specific sub-populations [18]. Relatively, patients with acute HAV infection could consequently develop autoimmune hepatitis (AIH) [22,23]; AIH can progress to liver cirrhosis and the subsequent development of HCC [24,25]. Therefore, HAV-related AIH may also potentially indirectly contribute to liver oncogenesis.…”

Section: Hepatitis Amentioning

confidence: 99%

Viral Hepatitis and Hepatocellular Carcinoma: State of the Art

et al. 2021

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Viral hepatitis is one of the main causes leading to hepatocellular carcinoma (HCC). The continued rise in incidence of HCC suggests additional factors following infection may be involved. This review examines recent studies investigating the molecular mechanisms of chronic hepatitis and its association with hepatocarcinogenesis. Hepatitis B virus patients with genotype C display an aggressive disease course leading to HCC more than other genotypes. Furthermore, hepatitis B excretory antigen (HBeAg) seems to be a more sensitive predictive tumor marker exhibiting a six-fold higher relative risk in patients with positive HBsAg and HBeAg than those with HBsAg only. Single or combined mutations of viral genome can predict HCC development in up to 80% of patients. Several mutations in HBx-gene are related with higher HCC incidence. Overexpression of the core protein in HCV leads to hepatocellular lipid accumulation associated with oncogenesis. Reduced number and decreased functionality of natural killer cells in chronic HCV individuals dysregulate their surveillance function in tumor and viral cells resulting in HCC. Furthermore, high T-cell immunoglobulin and mucin 3 levels supress CD8+ T-cells, which lead to immunological dysregulation. Hepatitis D promotes HCC development indirectly via modifications to innate immunity, epigenetic alterations and production of reactive oxygen species with the LHDAg being the most highly associated with HCC development. Summarizing the results, HBV and HCV infection represent the most associated forms of viral hepatitis causing HCC. Further studies are warranted to further improve the prediction of high-risk patients and development of targeted therapeutics preventing the transition from hepatic inflammation–fibrosis to cancer.

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An Outbreak Presents An Opportunity to Learn About A Rare Phenotype: Autoimmune Hepatitis After Acute Hepatitis A

Cited by 7 publications

References 14 publications

Local and systemic autoimmune manifestations linked to hepatitis A infection

Local and systemic autoimmune manifestations linked to hepatitis A infection

Immune disorders and rheumatologic manifestations of viral hepatitis

Viral Hepatitis and Hepatocellular Carcinoma: State of the Art

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