Latent autoimmune hepatitis triggered during interferon therapy in patients with chronic hepatitis C |
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Authors: | Luisa Garcí a-Buey,Carmelo Garcí a-Monzó n,Santiago Rodriguez,Marí a J. Borque,Asunció n Garcí a-Sá nchez,Rosa Iglesias,Mar DeCastro,Fernando G. Mateos,José L. Vicario,Antonio Balas,Ricardo Moreno-Otero |
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Affiliation: | ∗Liver, Hospital de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain;‡Molecular Biology Units, Hospital de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain;§Pathology Service, Hospital de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain;∥Centro de Transfusiones de la CAM, Madrid, Spain |
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Abstract: | Interferon can induce autoantibodies and autoimmune reactions. This study reviewed the clinical, serological, and HLA phenotypical features of patients who developed autoimmune hepatitis during interferon therapy for chronic hepatitis C, analyzing their response to immunosuppressive treatment. The diagnosis of chronic hepatitis C was based on positivity for viral RNA and a liver biopsy specimen obtained before interferon treatment. Sera were tested for autoantibodies by indirect immunofluorescence assay. HLA typing was performed by applying a standard microlymphocytotoxicity method. Of 144 patients with chronic hepatitis C treated with interferon, 7 women deteriorated during treatment; serum transaminase, γ-globulin, and immunoglobulin G levels increased; and serum autoantibodies became positive. Interferon was interrupted, a diagnosis of autoimmune hepatitis was established, and immunosuppressive therapy was initiated. All patients responded to this treatment. The 7 patients had similar HLA typing to those with autoimmune hepatitis, with DR4 in 2 patients (67%) with type 2 autoimmune hepatitis, and with DR3 and DR52 in 2 (50%) and 4 (100%) patients, respectively, with type 1 autoimmune hepatitis; additionally, 5 patients (71%) had DQ2, and 4 (57%) had both DR52 and DQ2. In female patients with chronic hepatitis C, a genetic susceptibility to autoimmune hepatitis may exist, possibly triggered by immunostimulating effects during interferon therapy. Immunosuppressive treatment has been well tolerated and seems to be effective. |
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Keywords: | Abbreviations: AIH, autoimmune hepatitis AMA, antimitochondrial antibodies ANA, antinuclear antibodies CHC, chronic hepatitis C HAI, histological activity index IFN, interferon LKM-1, liver/kidney microsome type 1 SMA, smooth muscle antibodies TGA, thyroglobulin autoantibodies TMA, thyroid microsome autoantibodies |
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