Type C-chronic hepatitis patients who had autoimmune phenomenon and developed jaundice during interferon therapy

Abstract

Of a total of 2342 patients with type-C chronic hepatitis treated with interferon (IFN) at this hospital, 3 patients developed jaundice during the course of IFN therapy, but all 3 of them exhibited negative conversion of hepatitis C virus (HCV)-RNA following readministration of IFN. All 3 patients were assessed as having "probable autoimmune hepatitis (AIH)" in accordance with the AIH scoring system, indicating association with an "autoimmune phenomenon". Readministration of IFN at a low-dose induced activation of the autoimmune phenomenon, leading to fulminant hepatocellular impairment. As a result, HCV-RNA content dropped dramatically, possibly contributing to the negative conversion of HCV-RNA noted following the readministration of IFN. At present, no adequate therapy has been established for type-C chronic hepatitis with autoimmune manifestations. However, in conclusion, our findings suggested that: IFN should be a frontline regiment: (1). if autoantibody titers are low or patients are rated as having "probable AIH" or lower in accordance with the AIH scoring system, indicating a strong link to chronic hepatitis or (2). if IFN is expected to be efficacious on the basis of genotype of HCV-RNA level; even if there is acute exacerbation of type-C chronic hepatitis, IFN should be re-administered in the HCV-RNA level has dropped subsequently.

Circulating IL17a and IFN-Gamma Serum Levels in Cirrhotic Hepatitis C Virus Infected Patients with Autoimmune Thyroiditis

“…In the present study, serum ALT and AST level were significant elevated in ANA positive group than ANA negative group (pvalue > 0.0001).This results come in accordance with Sezaki et al who reported that ALT level is higher in patients with autoimmune diseases (Sezaki et al, 2003).…”

Acute Exacerbation of Liver Disease Induced by Pegylated Interferon Alpha2a Treatment for Chronic Hepatitis C

“…With regard to the treatment of autoimmune hepatitis induced by IFN, corticosteroid is reported to be effective [5,6,15]. In our patient, her ALT level began to decrease immediately after the administration of 500 mg of methylprednisolone, and her total bilirubin level also gradually decreased after the beginning of the therapy.…”

“…Of a total of 2,342 chronic hepatitis C patients treated with IFN in their institute, only 3 patients (0.1%) developed jaundice during or after IFN treatment, and they concluded that jaundice rarely develops in patients with hepatitis C during or after IFN therapy [6]. They also reported that the 3 patients had an autoimmune score of "probable AIH" prior to the initiation of IFN therapy and therefore that autoimmune scoring before IFN therapy would be a useful tool for predicting the development of autoimmune hepatitis [6]. However, in daily practice, it is not practical to investigate HLA haplotype and liver histology in all patients who undergo IFN therapy.…”

“…It is also known that IFNαinduces autoimmune disease and activates subclinical autoimmune diseases, such as thyroiditis, hemolytic anemia, and autoimmune hepatitis [4]. IFNα-induced acute exacerbation of liver disease leading to jaundice is extremely rare [5,6]. Here, we report a case of Peg-IFN alpah2a plus ribavirin therapy induced liver failure in which an auto-immune mechanism was considered as its etiology.…”

Autoimmune Hepatitis and Thyroiditis Associated with Rifampin and Pyrazinamide Prophylaxis: An Unusual Reaction

“…Both total protein and albumin were normal (6.4 and 4.0 g/dL, respectively). However, the TSH was very low, at 0.03 µIU/L (normal, 0.5-5.5 µIU/L); total T3 was mildly elevated, at 179.12 ng/dL (normal, 87-178 ng/dL); T4 was 8.9 µg/dL (normal, 6.09-12.23 µg/dL); and free T4 was [9][10][11][12][13][14] Multiple + (80%) + (72%) Minocycline [15][16][17][18][19][20][21] Multiple [24][25][26][27] Multiple [41][42][43][44] IR + + Atorvastatin [45,46] IR + + Germander [47,48] IR + + Propylthiouracil [49][50][51][52] IR + + Diclofenac [53,54] IR + − Pemoline [55] IR + − Antimicrosomal Doxycycline [56] IR + − Benzarone [57] IR − + Fenofibrate [58] − − Dai-saiko-to (herb) [59] IR + +…”