Autoimmune hepatitis: a manifestation of immune reconstitution inflammatory syndrome in HIV infected patients?

Murunga, Eric; Andersson, Monique; Rensburg, Christo van

doi:10.3109/00365521.2016.1157888

Cited by 15 publications

(5 citation statements)

References 23 publications

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“…(7-10) In these patients, there was laboratory and anatomopathological confirmation of autoimmune hepatitis similar to the case of our patient. The time relationship between antiretroviral initiation and the development of the clinical picture allows arguing in favor of IRIS as a triggering factor of the autoimmune hepatitis in this patient.…”

Section: Discussionsupporting

confidence: 82%

Immune reconstitution inflammatory syndrome as a cause of autoimmune hepatitis and acute liver failure

Filho

Fernandes

Susin

et al. 2017

Revista Brasileira De Terapia Intensiva

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Acute liver failure is a rare syndrome with high mortality and is often diagnosed late. Intensivist physicians play fundamental roles in the diagnostic suspicion and the management of the multiple-organic dysfunctions characteristic of this entity. Immune reconstitution inflammatory syndrome is an entity that is characterized by the paradoxical worsening of the patient's previous condition, after the initiation of antiretrovirals, triggered against either pathogens present in the host or autoantigens. Autoimmune hepatitis has recently been described as one of these autoimmune manifestations. The authors report the first case with evolution to acute liver failure and death within a few days after the development of encephalopathy, review the cases of autoimmune hepatitis described and comment on the therapeutic possibilities in this context.

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Section: Discussionsupporting

confidence: 82%

Immune reconstitution inflammatory syndrome as a cause of autoimmune hepatitis and acute liver failure

Filho

Fernandes

Susin

et al. 2017

Revista Brasileira De Terapia Intensiva

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“…It has been described that chronic HCV infection leads to impairment in innate and adaptive immune responses. As DAA therapy has been found to reverse some of these immune disturbances indirectly through viral clearance, a parallel can be made with the immune reconstitution inflammatory syndrome occurring after highly active antiretroviral therapy in patients with HIV, which may result in severe autoimmune hepatitis . Persistent lymphoid aggregates that are typically seen in chronic hepatitis C have been noted after SVR .…”

Section: Discussionmentioning

confidence: 99%

Immune-mediated graft dysfunction in liver transplant recipients with hepatitis C virus treated with direct-acting antiviral therapy

Chan

Schiano

Agudelo

et al. 2018

American Journal of Transplantation

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Interferon treatment of hepatitis C virus (HCV) infection after liver transplantation (LT) can result in immune-mediated graft dysfunction (IGD). The occurrence of, risk factors for, and outcomes of IGD with direct-acting antiviral (DAA) therapy have not been reported. We conducted a multicenter study of HCV+LT recipients who did or did not develop DAA-IGD (1 case: 2 controls-33 vs 66). Among all treated between 2014 and 2016, DAA-IGD occurred in 3.4% (33/978). IGD occurred only after treatment completion (76.0 [IQR, 47.0;176]). Among those treated, 48% had plasma cell hepatitis, 36% acute cellular rejection, 6% chronic rejection, and 9% combined findings. Median time to liver enzyme resolution was 77.5 days (IQR, 31.5;126). After diagnosis, hospitalizations, steroid-induced hyperglycemia, and infection occurred in a higher percentage of cases vs controls (33% vs 7.5%, 21% vs 1.5%, 9% vs 0%; all P < .05). Only one IGD patient died and none required retransplant. A multivariate regression analysis found that liver enzyme elevations during and soon after DAA therapy completion correlated with subsequent IGD. In conclusion, while DAA-IGD is uncommon, liver enzyme elevations during or after DAA therapy may be a sign of impending IGD. These indicators should guide clinicians to diagnose and treat IGD early before the more deleterious later clinical presentation.

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“…There have been several case reports of AIH developed as part of immune reconstitution inflammatory syndrome after highly active antiretroviral therapy (HAART) in HIV infected patients [17]. The mechanism that results in AIH after initiation of HAART in HIV patient is probably involves changes in CD4+ T cells [18]. The rapid increase in CD4+ T cells may produce a larger proportion of Th17 cells that release IL-17 without appropriate Treg cells numerical and functional reconstitution, which are similar to AIH.…”

Section: Discussionmentioning

confidence: 99%

Favorable effect of corticosteroids in treating acute-on-chronic liver failure underlying chronic hepatitis B

et al. 2018

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Acute-on-chronic liver failure (ACLF) occurs in the presence of a chronic liver disease or cirrhosis, and often results from exacerbation of chronic hepatitis B (CHB). The efficacy of corticosteroid treatment in ACLF patients with underlying CHB remains unclear. We report the case of a 50-year-old woman who experienced ACLF due to CHB exacerbation and was treated with a combination of corticosteroids and nucleot(s)ide analogue (NUC). The patient showed rapid decompensation due to CHB exacerbation. Three months of antiviral therapy produced no improvement in liver function. Combination therapy with corticosteroids and NUC was started, which did result in improvement of liver function. This case shows that the combined therapy of corticosteroids and NUC can be effective in treating ACLF due to CHB exacerbation.

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Autoimmune hepatitis: a manifestation of immune reconstitution inflammatory syndrome in HIV infected patients?

Cited by 15 publications

References 23 publications

Immune reconstitution inflammatory syndrome as a cause of autoimmune hepatitis and acute liver failure

Immune reconstitution inflammatory syndrome as a cause of autoimmune hepatitis and acute liver failure

Immune-mediated graft dysfunction in liver transplant recipients with hepatitis C virus treated with direct-acting antiviral therapy

Favorable effect of corticosteroids in treating acute-on-chronic liver failure underlying chronic hepatitis B

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