2014, Number 1
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Ann Hepatol 2014; 13 (1)
Autoimmune hepatitis in patients with chronic HBV and HCV infections: patterns of clinical characteristics, disease progression and outcome
Rigopoulou EI, Zachou K, Gatselis N, Koukoulis GK, Dalekos GN
Language: English
References: 35
Page: 127-135
PDF size: 96.92 Kb.
ABSTRACT
We retrospectively investigated the characteristics, patterns of disease progression, outcome and difficulties
in the management in 11 patients with concurrent autoimmune hepatitis (AIH) and HBV or HCV infections
(5 HCV and 6 HBV including 2 with HDV co-infection) since there are scarce data on this issue. HCV
or HBV diagnosis preceded that of AIH in all patients by many years. At initial clinical and histological assessment
almost half of patients had cirrhosis (45.5%) with the group of AIH and HCV carrying the highest
frequency (4/5; 80%). In two thirds of patients, mostly with HCV and HBV/HDV, AIH was assumed to be IFNalpha-
induced and experienced difficulties in achieving sustained virological response. On the contrary,
the outcome of patients with HBV and AIH was better compared to those with AIH and HCV or HDV. In conclusion,
chronic viral hepatitis infections concomitant with AIH are often very difficult to recognize and
therefore, a significant delay in AIH diagnosis in this specific group of patients is usual. HBV patients with
concomitant AIH seem to carry the most favorable outcome compared to those with HCV probably because
of the use of nucleos(t)ide analogues which contrary to IFN-alpha can control HBV replication with no
adjacent effect, related to exacerbation of autoimmune phenomena.
REFERENCES
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B virus infection. J Hepatol 2012; 57: 167-85.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol 2011; 55: 245-64.
Stefos A, Gatselis N, Zachou K, Rigopoulou E, Hadjichristodoulou C, Dalekos GN. Descriptive epidemiology of chronic hepatitis B by using data from a hepatitis registry in Central Greece. Eur J Intern Med 2009; 20: 35-43.
Gatselis NK, Rigopoulou E, Stefos A, Kardasi M, Dalekos GN. Risk factors associated with HCV infection in semi-rural areas of central Greece. Eur J Intern Med 2007; 18: 48-55.
Krawitt EL. Autoimmune hepatitis. N Engl J Med 2006; 354: 54-66.
Zachou K, Gatselis N, Papadamou G, Rigopoulou EI, Dalekos GN. Mycophenolate for the treatment of autoimmune hepatitis: prospective assessment of its efficacy and safety for induction and maintenance of remission in a large cohort of treatment-naïve patients. J Hepatol 2011; 55: 636-46.
Dalekos GN, Zachou K, Liaskos C, Gatselis N. Autoantibodies and defined target autoantigens in autoimmune hepatitis: an overview. Eur J Intern Med 2002; 13: 293-303.
Gatselis NK, Georgiadou SP, Koukoulis GK, et al. Clinical significance of organ- and non-organ-specific autoantibodies on the response to anti-viral treatment of patients with chronic hepatitis C. Aliment Pharmacol Ther 2006; 24: 1563-73.
Cassani F, Cataleta M, Valentini P, et al. Serum autoantibodies in chronic hepatitis C: comparison with autoimmune hepatitis and impact on disease profile. Hepatology 1997; 26: 561-6.
Muratori P, Muratori L, Guidi M, et al. Clinical impact of non-organ-specific autoantibodies on the response to combined antiviral treatment in patients with hepatitis C. Clin Infect Dis 2005; 40: 501-7.
Williams MJ, Lawson A, Neal KR, Ryder SD, Irving WL. Autoantibodies in chronic hepatitis C virus infection and their association with disease profile. J Viral Hepat 2009; 16: 325-31.
Dalekos GN, Wedemeyer H, Obermayer-Straub P, et al. Epitope mapping of cytochrome P4502D6 autoantigen in patients with chronic hepatitis C during alpha-interferon treatment. J Hepatol 1999; 30: 366-75.
Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-38.
Hennes EM, Zeniya M, Czaja AJ, et al. International Autoimmune Hepatitis Group. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology 2008; 48: 169-76.
Manns MP, Czaja AJ, Gorham JD, et al. Diagnosis and management of autoimmune hepatitis. Hepatology 2010; 51: 2193-213.
Wedemeyer H, Yurdaydìn C, Dalekos GN, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med 2011; 364: 322-31.
Muratori L, Lenzi M, Cataleta M, et al. Interferon therapy in liver/kidney microsomal antibody type 1-positive patients with chronic hepatitis C. J Hepatol 1994; 21: 199-203.
Zachou K, Rigopoulou E, Dalekos GN. Autoantibodies and autoantigens in autoimmune hepatitis: important tools in clinical practice and to study pathogenesis of the disease. J Autoimmune Dis 2004; 1: 2.
Czaja AJ, Nishioka M, Morshed SA, Haciya T. Patterns of nuclear immunofluorescence and reactivities to recombinant nuclear antigens in autoimmune hepatitis. Gastroenterology 1994; 107: 200-7.
Czaja AJ, Cassani F, Cataleta M, Valentini P, Bianchi FB. Antinuclear antibodies and patterns of nuclear immunoflorescence in type 1 autoimmune hepatitis. Dig Dis Sci 1997; 42: 1688-96.
Parveen S, Morshed SA, Arima K, et al. Antibodies to Ro/ La, Cenp-B, and snRNPs antigens in autoimmune hepatitis of North America versus Asia: patterns of immunofluorescence, ELISA reactivities, and HLA association. Dig Dis Sci 1998; 43: 1322-31.
Vergani D, Alvarez F, Bianchi FB, et al. Liver autoimmune serology: a consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group. J Hepatol 2004; 41: 677-83.
Gregorio GV, Jones H, Chouldhuri K, Vegnente A, Bortolotti F, Mieli-Vergani G, Vergani D. Autoantibody prevalence in chronic hepatitis B virus infection: effect of interferon alpha. Hepatology 1996; 24: 308-12.
Gregorio GV, Pensati P, Iorio R, Vegnente A, Mieli-Vergani G, Vergani D. Autoantibody prevalence in children with liver disease due to chronic hepatitis C virus (HCV) infection. Clin Exp Immunol 1998; 112: 471-6.
Muratori P, Muratori L, Stroffolini T, et al. Prevalence of non-organ specific autoantibodies in HCV-infected subjects in the general population. Clin Exp Immunol 2003; 131: 118-21.
Dalekos GN, Makri E, Loges S, et al. Increased incidence of anti-LKM autoantibodies in a consecutive cohort of HCV patients from central Greece. Eur J Gastroenterol Hepatol 2002; 14: 35-42.
Zachou K, Liaskos C, Christodoulou DK, et al. Anti-cardiolipin antibodies in patients with chronic viral hepatitis are independent of beta2-glycoprotein I cofactor or features of antiphospholipid syndrome. Eur J Clin Invest 2003; 33: 161-8.
Hsieh MY, Dai CY, Lee LP, et al. Antinuclear antibody is associated with a more advanced fibrosis and lower RNA levels of hepatitis C virus in patients with chronic hepatitis C. J Clin Pathol 2008; 61: 333-7.
Ferri S, Muratori L, Quarneti C, et al. Clinical features and effect of antiviral therapy on anti-liver/kidney microsomal antibody type 1 positive chronic hepatitis C. J Hepatol 2009; 50: 1093-101.
Wasmuth HE, Stolte C, Geier A, et al. The presence of nonorgan- specific autoantibodies is associated with a negative response to combination therapy with interferon and ribavirin for chronic hepatitis C. BMC Infect Dis 2004; 4: 4.
Aoki YH, Ohkoshi S, Yamagiwa S, et al. Characterization of elevated alanine aminotransferase levels during pegylated- interferon a-2b plus ribavirin treatment for chronic hepatitis C. Hepatol Res 2011; 41: 118-25.
Thurairajah PH, Thorburn D, Hubscher S, et al. Incidence and characterization of serum transaminases elevations in pegylated interferon and ribavirin treated patients with chronic hepatitis C. Aliment Pharmacol Ther 2007;25:1293-300.
Papamichalis PA, Zachou K, Koukoulis GK, et al. The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders. J Autoimmune Dis 2007; 4: 3.
Gatselis NK, Zachou K, Papamichalis P, et al. Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score? Dig Liver Dis 2010; 42: 807-12.
Azhar A, Niazi MA, Tufail K, Malek AH, Balasubramanian M, Araya V. A new approach for treatment of hepatitis C in hepatitis C-autoimmune hepatitis overlap syndrome. Gastroenterol Hepatol (NY) 2010; 6: 233-6.