High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders

Pivetti, S; Novarino, Anna; Merico, F.; Bertero, Maria Tiziana; Brunetto, Maurizia Rossana; Bonino, Ferruccio; Caligaris-Cappio, Federico

doi:10.1046/j.1365-2141.1996.7542376.x

Cited by 62 publications

(60 citation statements)

References 37 publications

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“…30,31,37 Epidemiology Six cross-sectional studies have reported serologic evidence of HCV infection in 159 of 799 (20%) patients with a clinical diagnosis of CITP (Table 1). 30,31,[37][38][39][40] In the largest series published to date, HCV antibodies were identified in 76 (30%) of 250 patients fulfilling the ASH guideline criteria for CITP. 31 There were significant differences in demographic characteristics of patients with HCV-positive compared with HCV-negative CITP.…”

Section: Hcv Infectionmentioning

confidence: 99%

Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

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Chronic immune thrombocytopenic purpura (CITP) is a diagnosis of exclusion that occurs either de novo or secondary to other underlying disorders. Chronic infection with human immunodeficiency virus (HIV)andChronic immune thrombocytopenic purpura (CITP) is characterized by accelerated platelet destruction and variably impaired platelet production resulting in thrombocytopenia. CITP has been classified either as a primary autoimmune disorder (idiopathic thrombocytopenic purpura) or as secondary to a number of underlying disorders. Common conditions associated with secondary CITP include lymphoproliferative disorders and other autoimmune collagen vascular diseases. CITP is also associated with certain chronic infections. While the association between human immunodeficiency virus (HIV) infection and immune thrombocytopenia has been well known for over 20 years, recent studies have suggested that infection with Helicobacter pylori or hepatitis C virus (HCV) may be an even more frequent cause of chronic thrombocytopenia.The relationship between these chronic infections and the development of immune-mediated thrombocytopenia represents a largely unexplored paradigm in which the host response to an infectious agent results in a loss of immune self-regulation. The pathophysiology of infection-related ITP involves diverse immunologic pathways as well as nonimmune mechanisms that accelerate platelet destruction and/or decrease platelet production. A diagnosis of CITP associated with these chronic infections must include consideration of other potential causes of thrombocytopenia. For example, thrombocytopenia with HCV infection can also result from the hepatic cirrhosis leading to portal hypertension with splenic platelet sequestration and/or decreased hepatic production of thrombopoietin. However, the relationship between the infectious agent itself and the development of thrombocytopenia is clearly demonstrated by the improvements in platelet counts that follows successful treatment of the underlying infection. Therefore, the diagnostic and therapeutic algorithm for managing infection-related ITP can differ significantly from that of primary, i.e., idiopathic, thrombocytopenic purpura.

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Section: Hcv Infectionmentioning

confidence: 99%

Viral-Associated Immune Thrombocytopenic Purpura

Liebman

2008

Hematology

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“…Studies have reported that idiopathic thrombocytopenic purpura (ITP) develops more frequently in patients with HCV infection than in healthy persons (15)(16)(17). HCV may contribute to or trigger the development of ITP, mediated in particular by circulating immune complexes (15).…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia as a Clinical Manifestation of Hepatitis C Among Patients With a Positive Anti-HCV Test

et al. 2016

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Background: The hepatitis C virus (HCV) has been recognized as the cause of thrombocytopenia (defined as a platelet count of < 150,000 platelets/uL) occurring in patients with chronic hepatitis C. Thrombocytopenia occurs in 64% -76% of patients with cirrhosis and/or fibrosis, compared with 6% of non-cirrhotic patients with chronic liver disease. Objectives: The aim was to study the prevalence of thrombocytopenia in HCV patients without cirrhosis and splenomegaly. Patients and Methods: A cross-sectional study was carried out in the gastrointestinal out patient department (G.I. OPD) of the Sindh institute of urology and transplantation (SIUT) from September-November 2013. 30 patients aged between 18 -60 years with a positive anti-HCV result were included. Patients with enlarged spleen, liver cirrhosis on an ultrasound of the abdomen, and thrombocytopenia related to other causes were excluded from the study.

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“…Mixed essential cryoglobulinemia has been reported in 80% to 90% of patients with HCV. 19 The immune response against HCV infection leads to the production of IgM rheumatoid factor, which can bind to HCV-IgG (type 2 cryoglobulinemia). Anticardiolipin antibodies may also bind to platelets, causing platelet destruction.…”

Section: Discussionmentioning

confidence: 99%

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

Karakan

Cındoruk

Değertekın

et al. 2005

Current Therapeutic Research

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Background: Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon 0FN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Objective: The aim of this report was to present the case of a male patient with severe symptomatic thrombocytopenia due to HCV infection. Methods:Thrombocytopenia was treated with pegylated IFN plus ribavirin. Results: Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects. Conclusions: INTRODUCTIONExtrahepatic manifestations of hepatitis C virus (HCV) infection are observed in -38% to 50% of cases~; one of these manifestations is mild to moderate thrombocytopenia. Hepatic disease or cirrhosis with portal hypertension commonly leads to hypersplenism-related thrombocytopenia. Nonetheless, thrombocytopenia is more severe in HCV infections than in other hepatic diseases, possibly because of increased autoimmunity related to HCV infection. In HCV-related thrombocytopenia and idiopathic thrombocytopenic purpura (ITP), large thrombocytes are seen on peripheral smears, and a normal or elevated megakaryocyte count is seen in bone marrow aspirates, indicating peripheral destruction of thrombocytes. Interferons (IFNs) are used in clinical practice for the treatment of HCV infection. 1 Standard IFN monotherapy has been reported in some studies. 1 Although the main effect of IFNs on HCV is the suppression of replication, 1 other beneficial effects include immunomodulation of the host immune system. However, the major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. 2 In addition, few studies have reported improvement in HCV-related thrombocytopenia with IFN therapy, 3 and current guidelines 4 do not mention the treatment of HCV-related thrombocytopenia with IFNs. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Herein we report a case of HCV-related severe thrombocytopenia treated with IFN alfa-2a, with a fluctuating response. The patient provided written consent to use this material for publication.

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High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders

Cited by 62 publications

References 37 publications

Viral-Associated Immune Thrombocytopenic Purpura

Viral-Associated Immune Thrombocytopenic Purpura

Thrombocytopenia as a Clinical Manifestation of Hepatitis C Among Patients With a Positive Anti-HCV Test

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

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