Association of Autoantibody to Rods and Rings with Hepatitis C Outcome and Viral Load

Abstract

Despite the current availability of more potent drugs, hepatitis C virus (HCV) infection is still treated with a combination of IFN-a and ribavirin in many countries. Interferon/ribavirin therapy can induce the appearance of autoantibodies to Rods and Rings (anti-RR), which have been associated to a poorer prognosis. The aim of this study was to investigate the prevalence of anti-RR antibodies before and after ribavirin therapy and to look for a possible association with HCV infection outcome. In this context, anti-RR antibodies were detected by IFI on HEp-2 cells in 142 patients under ribavirin therapy (G1: 74 patients with a positive posttreatment HCV-PCR and G2: 68 patients with a negative posttreatment HCV-PCR, matched in age and gender), 84 kidney transplant recipients (KTRs) under mycophenolate and 158 controls (30 with systemic lupus erythematosus, 37 with rheumatoid arthritis, and 91 healthy blood donors). No patient had anti-RR antibody before IFN-a/ribavirin therapy, while 27 (19%) developed the anti-RR pattern under treatment. The anti-RR antibody was absent in all KTRs and the 158 controls. The frequency of anti-RR antibody was significantly higher in G1 (27; 36.48%) than in G2 (0), p < 0.001. Moreover, and in G1, anti-RR antibody was more frequent in nonresponders (NR) patients (23, 56.1%) than in relapsers (REL) (4, 12.1%); p < 0.001, OR [95%CI] = 9.26 [2.75-31.18]. Moreover, anti-RR antibody titer was significantly higher in NR patients (3,200 [1,600-6,400]) comparatively to REL patients (800 [500-1,400]), p = 0.002. Likewise, log of viral load postribavirin therapy was significantly higher in anti-RR positive patients (6.24-0.64) than in anti-RR negative (4.69-1.06), p < 0.001. Based on these findings, ribavirin-induced anti-RR autoantibody seems to be associated with a more frequent nonresponse to IFN-a/ribavirin therapy with a significant higher HCV viral load.

The relevance between anti‐rods/rings antibody and different treatment regimens in chronic hepatitis C virus infection

“…Studies have shown that anti-RR positivity rates range from 14.1% to 38%. 7,19 A study by Alsius et al 20 found that the rate of anti-RR in patients with HCV infection was 9.2% with similar treatment groups, whereas in our study this was 15.16%. In the long-term study of da Silva Sacerdote et al 18 this rate was 23% in patients who had received PEG-IFN/RBV.…”

“…PEG‐IFN and RBV were coadministered to all patients who had anti‐RR positivity. Studies have shown that anti‐RR positivity rates range from 14.1% to 38% 7,19 . A study by Alsius et al 20 .…”

The clinical value of indirect immunofluorescence for screening anti-rods and rings antibodies: A retrospective study of two centers in China

“…This seems to indicate that anti-RR is a druginduced autoantibody. However, recently some scholars also have found that anti-RR antibodies can exist in patients with hepatitis C before antiviral treatment or non-hepatitis C patients, patients with the therapy of other drugs, and even healthy people (36)(37)(38). The interaction between HCV protein and RR structure may not be necessary.…”

The value of anti‐rods and rings antibodies in Chinese population of Dalian City: A retrospective study

“…Interferon/ribavirin therapy can induce the appearance of anti‐RR, which has been associated with a poorer prognosis. Ribavirin‐induced anti‐RR autoantibody seems to be associated with a more frequent nonresponse to IFN‐α/ribavirin(IFN/RBV) therapy with a significantly higher HCV viral load 7 …”