Hepatitis Associated Antigen and Periarteritis Nodosa (PAN)

Trépo, C; Thivolet, J

doi:10.1111/j.1423-0410.1970.tb01550.x

Cited by 104 publications

(18 citation statements)

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“…HBV has been considered among the etiologic agents of PAN in 36% of cases 5 . This association, first described by Trépo and Thivolet 26 and Gocke et al 3 , has been confirmed by many reports 5,21 . Estimates of the annual incidence of PAN in a general population range from 4.6 per 1,000,000 in England 23 to 31 per 1,000,000 in France 17 and 77 per 1,000,000 in a hepatitis B hyperendemic Alaskan Eskimo population 18 .…”

Section: Introductionsupporting

confidence: 64%

Hepatitis B Virus-Associated Polyarteritis Nodosa

et al. 2005

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Hepatitis B virus-associated polyarteritis nodosa (HBV-PAN) is a typical form of classic PAN whose pathogenesis has been attributed to immune-complex deposition with antigen excess. We conducted the current study to 1) analyze the frequency of HBV infection in patients with PAN, in light of the classification systems described since 1990; 2) describe the clinical characteristics of HBV-PAN; 3) compare the evolution according to conventional or antiviral treatment; and 4) evaluate long-term outcome. One hundred fifteen patients were included in therapeutic trials organized by the French Vasculitis Study Group and/or referred to our department for HBV-PAN between 1972 and 2002. To determine the frequency of HBV-PAN during the 30-year period, we analyzed a control group of patients with PAN without HBV infection, followed during the same period and diagnosed on the same bases. Depending on the year of diagnosis, different treatments were prescribed. Before the antiviral strategy was established, some patients were given corticosteroids (CS) with or without cyclophosphamide (CY). Since 1983, treatment for patients with HBV markers has combined 2 weeks of CS followed by an antiviral agent (successively, vidarabine, interferon-alpha, and lamivudine) combined with plasma exchanges (PE).Ninety-three (80.9%) patients entered remission during this period and 9 (9.7%) of them relapsed; 41 (35.7%) patients died. For the 80 patients given the antiviral strategy as intention-to-treat, 4 (5%) relapsed and 24 (30%) died vs 5 (14.3%) relapses (not significant [NS]) and 17 (48.6%) deaths (NS) among the 35 patients treated with CS alone or with CY or PE. HBe-anti-HBe seroconversion rates for the 2 groups, respectively, were: 49.3% vs 14.7% (p < 0.001). Patients who seroconverted obtained complete remission and did not relapse.Thus, HBV-PAN, a typical form of classic PAN, can be characterized as follows: when renal involvement is present, so is renal vasculitis; glomerulonephritis due to vasculitis is never found; antineutrophil cytoplasmic antibodies (ANCA) are not detected; relapses are rare, and never occur once viral replication has stopped and seroconversion has been obtained. Combining an antiviral drug with PE facilitates seroconversion and prevents the development of long-term hepatic complications of HBV infection. The major cause of death is gastrointestinal tract involvement. Importantly, the frequency of HBV-PAN has decreased in relation to improved blood safety and vaccination campaigns.

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Section: Introductionsupporting

confidence: 64%

Hepatitis B Virus-Associated Polyarteritis Nodosa

et al. 2005

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“…In the 1970s, Trepo and Thivolet recognized that hepatitis B was significantly associated with PAN [9]. The ability of a virus to cause a systemic vasculitis was a remarkable discovery, and HBV-related PAN is considered the most typical form of PAN [4].…”

Section: Polyarteritis Nodosamentioning

confidence: 99%

Cutaneous Manifestations of Viral Hepatitis

Ahmed

Said

2015

Curr Infect Dis Rep

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There are several extrahepatic cutaneous manifestations associated with hepatitis B and hepatitis C virus infection. Serum sickness and polyarteritis nodosa are predominantly associated with hepatitis B infection, whereas mixed cryoglobulinemia associated vasculitis and porphyria cutanea tarda are more frequently seen in hepatitis C infection. The clinico-pathogenic associations of these skin conditions are not completely defined but appear to involve activation of the host immune system including the complement system. Management of the aforementioned cutaneous manifestations of viral hepatitis is often similar to that done in cases without viral hepatitis, with control of immune activation being a key strategy. In cases associated with hepatitis B and C, control of viral replication with specific antiviral therapy is also important and associated with improvement in most of the associated clinical manifestations.

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“…In 1988 [19,20], in conjunction with Trépo, who described the role of HBV in the development of PAN [6], we decided to treat HBV-related PAN with a combination of antiviral treatment and PE, after a short-term steroid regimen. Steroids and immunosuppressant agents were discontinued abruptly to remove stimulants of virus replication, which was essential for antiviral treatment efficacy.…”

Section: Treatment Of Hbv-related Panmentioning

confidence: 99%

“…A close relationship has been demonstrated between PAN and HBV infection [6]. In France, infections caused by contaminated blood transfusions have disappeared because of blood testing and donor selection, but intravenous drug use is becoming the major cause of HBV-related PAN [5••].…”

Section: Polyarteritis Nodosamentioning

confidence: 99%

Management of virus-induced systemic vasculitides

Guillevin

Cohen

2002

Curr Rheumatol Rep

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The best therapeutic strategy in virus-induced vasculitides should take into account the etiology of the disease and be adapted to the pathogenesis. The combination of antiviral treatments and plasma exchanges has been proven effective in polyarteritis nodosa. In HIV-related vasculitis, this strategy is effective and does not jeopardize the outcome of AIDS, as do cytotoxic agents. In vasculitis related to hepatitis C virus-associated cryoglobulinemia, plasma exchanges improve the outcome, but the poor effectiveness of antiviral drugs usually does not favor a definite recovery of the patients. Relapses are frequent.

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Hepatitis Associated Antigen and Periarteritis Nodosa (PAN)

Cited by 104 publications

References 0 publications

Hepatitis B Virus-Associated Polyarteritis Nodosa

Hepatitis B Virus-Associated Polyarteritis Nodosa

Cutaneous Manifestations of Viral Hepatitis

Management of virus-induced systemic vasculitides

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