Autoantibodies and Autoimmune Disease During Treatment of Children With Chronic Hepatitis C

Abstract

Objectives Auto-antibodies were studied in a well-characterized cohort of children with chronic hepatitis C (CHC) during treatment with PEG-IFN and ribavirin to assess the relationship to treatment and development of autoimmune disease. Methods 114 children (5–17 years), previously screened for the presence of high titer autoantibodies, were randomized to Peg-IFN with or without ribavirin. Anti-nuclear (ANA), anti-liver-kidney-microsomal (LKM), anti-thyroglobulin (TG), anti-thyroid peroxidase (TPO), insulin (IA2), anti-glutamic acid decarboxylase (GAD) antibodies were measured after trial completion using frozen sera. Results At baseline,19% had auto-antibodies: ANA (8%), LKM (4%), and GAD (4%). At 24 and 72 weeks (24 weeks after treatment completion), 23% and 26% had auto-antibodies (p=0.50, 0.48 compared to baseline). One child developed diabetes and two hypothyroidism during treatment; none developed autoimmune hepatitis. At 24 weeks, the incidence of flu-like symptoms, gastrointestinal symptoms, and headaches were 42%, 8% and 19% in those with auto-antibodies vs. 52%, 17%, and 26% in those without (p=0.18, 0.36, and 0.20, respectively). In children with negative HCV PCR at 24 weeks, there was no difference in the rate of early virologic response /sustained virologic response respectively in those with auto-antibodies 76%/69%, vs 58%/65% in those without (p=0.48). Conclusions Despite screening, we found autoantibodies commonly at baseline, during treatment for CHC and after. The presence of antibodies did not correlate with viral response, side effects, or autoimmune hepatitis. Neither screening nor archived samples assayed for thyroid and diabetes-related antibodies identified the 3 subjects who developed overt autoimmune disease, diabetes (1) and hypothyroidism (2).

Autoantibody to apolipoprotein A-1 in hepatitis C virus infection: a role in atherosclerosis?

“…In contrast to these dynamic changes in serum lipoprotein composition and concentration during DAA therapy, we found that the presence or absence of autoantibody to apoA-1 remained largely stable during sofosbuvir-based antiviral therapy and after virological cure over a short follow-up period. This is similar to experience in children with chronic hepatitis C receiving IFN-based anti-viral therapy where autoantibodies were found to be common at baseline, during and after treatment [31]. The vast majority of our patient cohort had received prior IFN-based antiviral therapy and IFN may induce autoimmune disorders or worsen pre-existing autoimmune disorders [32], so it will be important to establish whether the prevalence of anti-apoA-1 IgG is similar in untreated HCV infection.…”

Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection

“…This might implicate that autoimmunity induced by HCV should take place early in the course of infection and persist despite elimination of the virus. Compatibly, Molleston and colleagues reported that Peg-IFN-based treatment did not affect serum auto-antibodies in a paediatric cohort with HCV infection 39. In that study, auto-antibodies neither changed during the treatment nor differed between patients with and without viral clearance.…”

TSH receptor antibodies have predictive value for breast cancer – retrospective analysis

“…However, the ligand for TgAb, thyroglobulin (Tg), has antigenicity affected by the iodine content within the protein [18,38], and thus TgAb are present non-specifically in different diseases coexisting with the altered iodine intake [39]. More importantly, TgAb can be also found in patients with chronic disorders not involving thyroid [40] or even in healthy patients without any thyroid disease [41]. Thus, clinical impact of the elevated concentrations of TgAb is unreliable, as they were detected non-specifically to thyroid diseases or breast cancer.…”