Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals

Vento, Sandro; Garofano, Tiziana; Dolci, L; Perri, Giovanni Di; Concia, Ercole; Bassetti, Dante

doi:10.1016/0140-6736(91)92858-y

Cited by 287 publications

(140 citation statements)

References 18 publications

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“…however. might also be markers of an autoimmune process, triggered by a previous hepatitis virus infection (LENZI et al, 1991;VENTO et al, 1991). Histologically and clinically, however, we found neither chronic autoimmune hepatitis nor primary biliary cirrhosis in our survey, despite the rather high prevalence of ANA and AM2 autoantibodies among liver disease patients.…”

Section: Discussioncontrasting

confidence: 52%

Liver pathology in rural south-west Cameroon

Skalsky

Joller‐Jemelka

Bianchi

et al. 1995

Transactions of the Royal Society of Tropical Medicine and Hygi

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In a prospective study, 102 hospital patients with liver disease were evaluated in West Cameroon, Africa. Blood donors, pregnant women and patients without liver disease served as controls. A total of 757 individuals were tested for markers of hepatitis A, B, C and D and for immunological markers (autoantibodies, procollagen III, a-foetoprotein, CA50 antigen, or-1-antitrypsin and antibodies to human immunodeficiency virus types 1 and 2). One-third of the liver disease patients had focal lesions on ultrasound examination. Histologically, 20 cases of cirrhosis, 14 cases of chronic hepatitis, 15 hepatocellular carcinomas and 17 cases of acute hepatitis were detected. All hepatic patients and virtually all controls had had a previous hepatitis A virus infection. Over 85% of adult patients and controls had at least one marker of hepatitis B virus infection. Over 30% of patients with liver disease had markers of possible hepatitis B virus replication. Antihepatitis C virus antibody was present in 18% of hepatic patients and in 6% of controls. Hepatitis C virus infection seems to play an important role in the development of chronic liver pathology; 40% of cirrhotic patients had a combined hepatitis B and C virus infection, Serum autoantibodies were frequently found and were not correlated with the presence of autoimmune liver disease.

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Section: Discussioncontrasting

confidence: 52%

Liver pathology in rural south-west Cameroon

Skalsky

Joller‐Jemelka

Bianchi

et al. 1995

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…Vento et al 41 performed a prospective 4-year follow-up study in healthy relatives of 13 patients with AH. Three cases of subclinical acute hepatitis A were detected in this sample.…”

Section: Discussionmentioning

confidence: 99%

Protracted, but not acute, hepatitis A virus infection is strongly associated with HLA-DRB1*1301, a marker for pediatric autoimmune hepatitis

Velasco²,

et al. 2001

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HLA alleles are known to be associated with susceptibility to develop autoimmune hepatitis (AH), and hepatitis A virus (HAV) infection is postulated as a putative trigger for AH. We investigated whether HLA may influence the outcome of the HAV infection by studying 67 children with self-limited and 39 children with protracted forms of this infection. HLA typing of the uncomplicated forms showed no significant increase of any HLA class I or II alleles. In contrast, DRB1*1301 was present in 46.1% of the children with protracted forms (vs. 9.8% in healthy controls; relative risk [RR]: 7.6; 2 ‫؍‬ 33.3; P ‫؍‬ 2 ؋ 10 ؊9 ). In uncomplicated hepatitis, 45% developed anti-smooth muscle antibody (SMA)/actin antibodies, but only 1 child had detectable antibodies after 3 months of infection onset. In contrast, after 1 year, 69% of the patients suffering protracted forms had titers of anti-SMA/actin antibodies that ranged between 1:40 and 1:160. Within their follow-up, 2 patients developed a Hashimoto's thyroiditis, but the remaining patients showed no signs of developing autoimmune hepatitis. We conclude that the DRB1*1301 haplotype is strongly associated with the protracted forms of HAV infection and suggest that the infection allows a sustained release of liver self-antigens. However, other still-unknown susceptibility genes are required for the full development of pediatric AH. (HEPATOLOGY 2001;33:1512-1517

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“…However, it does not necessarily mean that the trigger for PBC (viral or xenobiotic) persists; for example, hepatitis A viral infection can trigger autoimmune hepatitis after the virus has been cleared. 24 Those are features of recurrent PBC; some of these are listed in Table 1.…”

Section: What Does Recurrence Of Disease Mean For the Pathogenesis Ofmentioning

confidence: 99%

Recurrent primary biliary cirrhosis

Neuberger

2003

Liver Transplantation

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T he rate of primary biliary cirrhosis (PBC) recurrence is uncertain and the different rates described in the literature reflect in part the diagnostic difficulties and in part the use of protocol biopsies, because histologic evidence of PBC recurrence is not always associated with the development of cholestatic liver tests.Recurrence of PBC appears to have little impact on long-term graft function and survival, but, with lengthening follow-up, this may become a greater problem. Whether ursodeoxycholic acid has any effect on the natural history of recurrent PBC has not been assessed.Recurrence of PBC may give some insight to the pathogenesis: The more rapid progression in the allograft compared with in the native liver, the early appearance in the graft of the aberrant distribution of E2 (the main target of the antimitochondrial antigen) and the increased rate of recurrence in those with tacrolimus as the main immunosuppressive agent is compatible with an infective trigger but clearly does not exclude other causes.Although there was some initial controversy, most centers now have reported recurrence of PBC: Recurrence is of importance not only for the patient and the clinician, but also gives potential insight into the etiology of the disease. The etiology of PBC remains uncertain, and the documentation of recurrence and understanding of risk factors may give useful tips concerning the pathophysiology of the condition and so lead to effective treatments.

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Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals

Cited by 287 publications

References 18 publications

Liver pathology in rural south-west Cameroon

Liver pathology in rural south-west Cameroon

Protracted, but not acute, hepatitis A virus infection is strongly associated with HLA-DRB1*1301, a marker for pediatric autoimmune hepatitis

Recurrent primary biliary cirrhosis

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