Autoimmune liver serology before and after successful treatment of chronic hepatitis C by direct acting antiviral agents

Beretta‐Piccoli, Benedetta Terziroli; C, Di Bartolomeo; Deleonardi, Gaia; Ag, Grondona; Silvestri, Tania; Tesei, Cristiano; Melidona, Laura; Cerny, Andreas; Mertens, Joachim C.; Semmo, Nasser; Semela, David; Moradpour, Darius; Mieli‐Vergani, Giorgina; Vergani, Diego; Muratori, Luigi

doi:10.1016/j.jaut.2019.04.019

Cited by 19 publications

(24 citation statements)

References 42 publications

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“…[12][13][14] These data raised the question as to whether a past HEV infection could be linked to the development of AIH as has previously been described with HEV and other viral infections. 2,4,5,21,22 In our area, the seroprevalence of HEV has been estimated to range between 7% 8 and 11%, 10 similar to what we found in patients with chronic AIH (10%). This is also similar to what has been reported in a Spanish population of patients with inflammatory bowel disease (IBD) under chronic immunosuppression, in whom the prevalence of anti-HEV IgM or IgG was low and did not differ from that of the general population (3% and 1% respectively).…”

Section: Discussionsupporting

confidence: 86%

“…Several studies have assessed the prevalence of anti‐HEV IgG antibodies in patients with AIH, which was found to be higher than that of the general local population . These data raised the question as to whether a past HEV infection could be linked to the development of AIH as has previously been described with HEV and other viral infections . In our area, the seroprevalence of HEV has been estimated to range between 7% and 11%, similar to what we found in patients with chronic AIH (10%).…”

Section: Discussionsupporting

confidence: 84%

“…Even though the pathophysiology of this disease is not well known, it has previously been suggested that viral infections may trigger the development of AIH in susceptible individuals since viral epitopes can mimic autoantigen epitopes in the liver. Indeed, several cases of AIH have been reported in patients with persistently altered liver tests after acute hepatitis A, B, C or E infection, Epstein‐Barr virus and human herpes 6 virus …”

Section: Introductionmentioning

confidence: 99%

“…Indeed, several cases of AIH have been reported in patients with persistently altered liver tests after acute hepatitis A, B, C or E infection, Epstein-Barr virus and human herpes 6 virus. [2][3][4][5] Hepatitis E virus (HEV) is a small positive-strand RNA genome with eight genotypes. Genotypes 1 and 2 cause epidemic outbreaks in developing countries, they only infect humans, and its transmission is faecal-oral.…”

Section: Introductionmentioning

confidence: 99%

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Higher seroprevalence of hepatitis E virus in autoimmune hepatitis: Role of false‐positive antibodies

Llovet

Gratacós‐Ginès

Ortiz

et al. 2020

Liver International

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Background and aims Recent studies have found an increase in the seroprevalence of hepatitis E virus (HEV) infection in patients with autoimmune hepatitis (AIH). We aimed to assess the prevalence of positive anti‐HEV IgM and IgG, and HEV‐RNA in a cohort of patients with AIH, to determine the impact of positive HEV serology on patient outcome, and to evaluate the role of hypergammaglobulinemia and positive autoantibodies in the presence of positive anti‐HEV serology. Methods One hundred and five patients tested for HEV infection between 2014 and 2018 were included in the study: 50 with chronic AIH (more than 1 year on treatment), and 55 with an acute hepatitis (30 patients with acute AIH and 25 with non‐AIH). Results Seroprevalence of HEV was higher in patients with acute AIH (17% vs 10% in patients with chronic AIH and 8% in patients with non‐AIH). Patients with acute AIH and positive anti‐HEV IgG were older (58 vs 40; P = .006), had higher IgG levels (27 g/dL vs 13 g/dL; P = .03) and antismooth muscle antibodies (ASMA) titres (1:160 vs 1:80; P = .045), and were more likely to have another autoimmune disease (60% vs 16%; P = .03). At the time of HEV testing, anti‐HEV IgG positive patients had significantly higher serum IgG levels (17 g/L vs 11 g/L; P = .009), ANA (1:160 vs 1:60; P = .026) and ASMA titres (1:80 vs 1:40; P = .021). Conclusion Seroprevalence of HEV in patients with AIH in Catalonia does not differ from that of the general population. The higher HEV seroprevalence in patients with acute AIH with higher levels of gammaglobulins and high antibody titres suggest the presence of cross‐reactivity between HEV and liver antigens.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Higher seroprevalence of hepatitis E virus in autoimmune hepatitis: Role of false‐positive antibodies

Llovet

Gratacós‐Ginès

Ortiz

et al. 2020

Liver International

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“…Hepatitis viruses that cause direct liver damage have naturally been suspects for the etiology of these diseases. Hepatitis C virus (HCV) has been closely associated with the development of AIH [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

Autoimmune liver disease-associated serologic profiling in Chinese patients with acute hepatitis E virus infection

Gui

Wang

et al. 2021

Immunol Res

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The association between hepatitis E virus (HEV) and autoimmune liver diseases has been well-researched; however, the focus has been on autoimmune hepatitis (AIH) and not primary biliary cholangitis (PBC). Therefore, we aimed to investigate the prevalence and evolution of AIH- and PBC-related autoantibodies in Chinese patients with HEV infection. In this retrospective study, 164 patients with acute HEV were included, specifically those whose liver autoantibody results were available and who had no pre-existing liver disease at the time of HEV diagnosis. Positive liver autoimmune serology was present in 69 (42.1%) patients and 21 (12.8%) had at least two autoantibodies at diagnosis. Greater age and alkaline phosphatase levels were independent risk factors for autoantibody positivity. Follow-up serologic tests, which were available for 27 of the 69 autoantibody-positive patients, showed that although antinuclear antibodies disappeared in 11/20 (55.0%) and antimitochondrial antibodies disappeared in 4/5 (80%) patients, 16 still remained positive for autoantibodies and two of them even developed new PBC-related antibodies, as described below. One patient developed a rim-like ANA pattern, accompanied by an enhancement of anti-gp210 positivity; and the other was diagnosed as PBC, based on chronic elevation of cholestatic enzymes and presentation with de novo AMA-M2, 18 months after HEV clearance. In conclusion, AIH- and PBC-related autoantibodies are frequently present during acute HEV infection, indicating that HEV should be excluded before diagnosing AIH and/or PBC. Importantly, some cases maintained or developed autoantibodies after viral clearance, and one patient subsequently developed PBC, highlighting that these individuals warrant long-term follow-up.

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Setting up criteria for drug‐induced autoimmune‐like hepatitis through a systematic analysis of published reports

et al. 2022

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Nitrofurantoin, minocycline, methyldopa and infliximab, have been found to induce autoimmune‐like hepatitis (DI‐AILH). Evidence for other drugs and herbal and dietary supplements (HDS) is unclear. The aims of the study were to establish criteria to define and review the published evidence of suspected DI‐AILH. Search was undertaken in Pubmed using search terms “drug‐induced liver injury,” “autoimmune hepatitis,” and “drug‐induced autoimmune hepatitis.” DI‐AILH was defined as (1) drug as a potential trigger of liver injury with autoimmune features and histological findings compatible with AIH; (2) no or incomplete recovery or worsening of liver tests after discontinuation of the drug; (3) corticosteroids requirement or spontaneous recovery; (4) follow‐up without immunosuppression (IS) and no relapse of AIH at least 6 months after discontinuation of IS; and (5) drugs potentially inducing AILH with a chronic course. Cases fulfilling the first four criteria were considered probable DI‐AILH with three possible DI‐AILH. A total of 186 case reports were identified for conventional drugs (n = 148; females 79%; latency 2.6 months) and HDS (n = 38; females 50%). The most commonly reported agents of DI‐AILH were interferons (n = 37), statins (n = 24), methylprednisolone (MPS) (n = 16), adalimumab (n = 10), imatinib (n = 8), and diclofenac (n = 7). Tinospora cordifolia and Khat were the only HDS with probable DI‐AILH cases. No relapses of AIH were observed when IS was stopped after interferons, imatinib, diclofenac, and methylprednisolone. Conclusion: Beyond well‐recognized nitrofurantoin, methyldopa, hydralazine, minocycline, and infliximab as causes of DI‐AILH, interferons, imatinib, adalimumab, and MPS were the best‐documented agents leading to probable DI‐AILH. Khat and Tinospora cordifolia were the only HDS found to be able to induce DI‐AILH. Long‐term immunosuppression appears to be rarely required in patients with DI‐AILH due to these drugs.

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Autoimmune liver serology before and after successful treatment of chronic hepatitis C by direct acting antiviral agents

Cited by 19 publications

References 42 publications

Higher seroprevalence of hepatitis E virus in autoimmune hepatitis: Role of false‐positive antibodies

Higher seroprevalence of hepatitis E virus in autoimmune hepatitis: Role of false‐positive antibodies

Autoimmune liver disease-associated serologic profiling in Chinese patients with acute hepatitis E virus infection

Setting up criteria for drug‐induced autoimmune‐like hepatitis through a systematic analysis of published reports

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