HCV‐marker‐positive autoimmune‐type chronic active hepatitis: a possible relation between HCV infection and liver autoreaction

Abstract

This study focused on 32 patients who were diagnosed as having autoimmune hepatitis based upon clinical and histological factors. Fifteen of these patients were positive for HCV‐RNA and for one of the HCV‐related markers tested, including anti‐C100, ELISA II, and RIBA 2 (Group 2). The remaining 17 patients were negative for all HCV‐related markers (Group 1). Clinical factors in the two groups, including the frequency of autoantibodies, serum levels of aminotransferase and gammaglobulin, HLA phenotypes, and the response to corticosteroid treatments, were compared. The titer of serum anti‐nuclear antibodies and the level of serum aminotransferase at initial diagnosis were significantly higher in Group 1 than in Group 2. Furthermore, the genetic background of the two groups, as indicated by HLA phenotypes, differed. All cases in Group 1 were HLA‐DR4‐positive, whereas only 60% of those in Group 2 cases had HLA‐DR4. Also, all cases in Group 1 but only 66.7% of the cases in Group 2 showed good clinical responses to corticosteroid treatment. Finally, no cases of HCV‐related‐marker‐positive autoimmune hepatitis (Group 2) had antibodies for LKM, suggesting that these cases were clinically different from type II autoimmune hepatitis. These data indicated that immunosuppressive treatment might be the preferred initial treatment in patients who either satisfy the criteria for AIH or who are sero‐positive for an HCV‐marker.

Successful steroid treatment in a patient with membranoproliferative glomerulonephritis associated with hepatitis C virus

“…However, patients with HCV-related autoimmunetype CAH treated with corticosteroids may show no significant elevation in the titers of HCV-RNA during the treatment course [8]. In addition, steroid therapy may be preferable as a first-or second-line agent for HCV-associated active glomerulonephritis [4].…”

“…Clinically, a patient with nephrotic syndrome following cryoglobulinemic MPGN induced by HCV with CAH, was reported to be successfully treated with low-dose corticosteroid (PSL). Various therapies have been proposed for MPGN associated with HCV: hormonal treatment (IFNa [2,[4][5][6]), immunosuppressive drugs (corticosteroids [4,8,9], cyclophosphamide [7]), antiviral drug (ribavirin [9][10][11]) and plasma exchange [9,12]. In particular, the use of corticosteroids and cyclophosphamide remain controversial.…”

“…The reported treatments of MPGN due to HCV include interferona (IFNa) [2,[4][5][6], cyclophosphamide [7], and corticosteroids [4,8,9].…”

Autoimmune hepatitis versus viral hepatitis C

“…Patients with HCV-associated LKM-1 autoimmunity are older, do not show a clear sex predominance, have lower aminotransferase and immunoglobulin levels, and do not have as many associated other autoimmune syndromes when compared to patients with AIH type 2 (32,. 49,52,53,58). The distinction between the two disease entities is particularly significant regarding therapy.…”