Hepatitis C virus infection as a determinant of behavior in type 1 autoimmune hepatitis

Abstract

To determine if hepatitis C virus infection influences the behavior of type 1 autoimmune hepatitis and to assess the performance parameters of third-generation immunoassays for viral infection in this disease, 64 patients with different patterns of disease behavior were assessed retrospectively for antibodies to hepatitis C virus by third-generation enzyme-linked immunosorbent assay and recombinant immunoblot assay and for HCV RNA by polymerase chain reaction. Hepatitis C virus RNA was detected in seven patients (11%) and antibodies to hepatitis C virus were found in five (8%). All patients who had an acute onset of illness or who sustained remission after therapy lacked HCV RNA in serum. In contrast, four of 31 patients who relapsed (13%) and three of 17 patients who failed treatment (18%) had HCV RNA in serum. Patients with HCV RNA were indistinguishable from those without HCV RNA; in three patients, infection was recognized only by testing for HCV RNA. Four of seven patients with HCV RNA responded fully to corticosteroids, although each relapsed after drug withdrawal. Smooth muscle antibodies (43% versus 91%, P = 0.006) and concurrent smooth muscle and antinuclear antibodies (0% versus 60%, P = 0.003) occurred less frequently in patients with HCV RNA than in counterparts without HCV RNA. The specificity of the third-generation enzyme immunoassay was 98% and its overall predictability was 94%. Its sensitivity, however, was 57% and false positive results occurred in 20%. Hepatitis C virus infection is an uncommon determinant of disease behavior in type 1 autoimmune hepatitis, but it may be present in relapse or treatment failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease

“…20 Furthermore, another condition may be superimposed on the original process, such as PSC, [21][22][23][24] viral infection, 25 drug toxicity, 26 or fatty liver disease, 27 which could alter treatment outcome. Last, treatment failure may reflect intrinsic pathogenic mechanisms promoted by host-dependent genetic predispositions that cannot be suppressed by conventional corticosteroid regimens.…”

Histological findings in chronic hepatitis C with autoimmune features

“…11 In other instances, they may identify individuals To evaluate the histological findings in patients with who respond adversely to interferon therapy, [12][13][14][15][16] and who chronic hepatitis C and autoimmune features, liver tissue might benefit from corticosteroid treatment. [17][18][19] In these latter specimens from 60 patients were graded under code for indicases, the autoimmune features may characterize a subgroup vidual features and composite patterns that denoted autoimwith immune-predominant pathogenic mechanisms. mune, viral, combined autoimmune and viral, and nondis-…”

A Case of Cholestatic Autoimmune Hepatitis and Acute Liver Failure: an Unusual Hepatic Manifestation of Mixed Connective Tissue Disease and Sjőgren's Syndrome

“…These two conditions can be excluded through liver biopsy and by the absence of antimitochondrial antibodies. It is important to distinguish AIH from viral hepatitis, especially hepatitis C. Hepatitis C often has similar clinicolaboratory and pathologic findings with AIH (8). Negative results of repeated tests for anti-HCV antibody and a good response to steroid therapy excluded the possibility of HCV infection in our patient.…”