1
|
de Castro GLC, da Silva Graça Amoras E, Araújo MS, da Silva Conde SRS, Bichara CDA, Queiroz MAF, Vallinoto ACR. High prevalence of antinuclear antibodies in patients with chronic hepatitis C virus infection. Eur J Med Res 2022; 27:180. [PMID: 36114565 PMCID: PMC9479388 DOI: 10.1186/s40001-022-00809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection is a serious public health concern due to its high prevalence and mortality rate. In chronic infection, HCV may induce autoimmune responses through the production of autoantibodies, including antinuclear antibodies (ANA). Methods We assessed the presence of ANA by indirect immunofluorescence using HEp-2 cells in 89 patients with chronic hepatitis C. We also collected data on epidemiological variables; clinical characteristics; and biochemical, hematological, molecular, and histopathological information from the patients to assess the impact of the presence of ANA in those patients. Results The prevalence of ANA in the patients was 20.2%, which was significantly higher than that found in healthy controls (2%). However, there was no association of this marker with epidemiological, clinical-laboratory, molecular or histopathological characteristics of hepatitis C, although a slightly higher prevalence of ANA was detected in women and in patients infected with subgenotype 1a. In a specific analysis, chronic HCV patients with the “rods and rings” cytoplasmic pattern had higher degrees of hepatic fibrosis than did ANA-negative patients. Conclusions The results confirm a greater predisposition to the presence of ANA in patients with HCV, which may be associated with a worse prognosis, especially in the presence of the “rods and rings” cytoplasmic pattern.
Collapse
|
2
|
Priora M, Borrelli R, Parisi S, Ditto MC, Realmuto C, Laganà A, Centanaro Di Vittorio C, Degiovanni R, Peroni CL, Fusaro E. Autoantibodies and Rheumatologic Manifestations in Hepatitis C Virus Infection. BIOLOGY 2021; 10:1071. [PMID: 34827064 PMCID: PMC8614641 DOI: 10.3390/biology10111071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
HCV is a virus that can cause chronic infection which can result in a systemic disease that may include many rheumatologic manifestations such as arthritis, myalgia, sicca syndrome, cryoglobulinemia vasculitis as well as other non-rheumatological disorders (renal failure, onco-haematological malignancies). In this population, the high frequency of rheumatoid factor (45-70%), antinuclear (10-40%) and anticardiolipin (15-20%) antibodies is a B-cell mediated finding sustained by the infection. However, the possibility that a primitive rheumatic pathology may coexist with the HCV infection is not to be excluded thus complicating a differential diagnosis between primitive and HCV-related disorders.
Collapse
Affiliation(s)
- Marta Priora
- Department of General and Specialistic Medicine, Rheumatology Clinic, Hospital of Mondovì, 12084 Cuneo, Italy
| | - Richard Borrelli
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Simone Parisi
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Maria Chiara Ditto
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Cristina Realmuto
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Angela Laganà
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Chiara Centanaro Di Vittorio
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Rosanna Degiovanni
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Clara Lisa Peroni
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| | - Enrico Fusaro
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (R.B.); (S.P.); (M.C.D.); (C.R.); (A.L.); (C.C.D.V.); (R.D.); (C.L.P.); (E.F.)
| |
Collapse
|
3
|
Păcurar D, Dijmărescu I, Dijmărescu A, Pavelescu M, Andronie M, Becheanu C. Autoimmune phenomena in treated and naive pediatric patients with chronic viral hepatitis. Exp Ther Med 2019; 18:5101-5104. [PMID: 31819772 PMCID: PMC6895782 DOI: 10.3892/etm.2019.8144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic viral hepatitis has been incriminated for inducing autoimmune events, but it is a known fact that interferon-based therapies also promote autoimmunity. We conducted an observational prospective study which included 114 pediatric patients with chronic viral hepatitis B and C. The patients were divided in 2 groups, the first group consisted of treatment-naive patients; the second group included patients who had received interferon-based therapy. We aimed to determine whether the ones who received treatment are more predisposed to developing autoimmune manifestations when compared to those naive. Fifty percent of the study group was found to have serological autoimmune phenomenon. Our research shows that the occurrence of the autoimmune phenomenon is delayed when the patient is treated with interferon-based regimens when compared to naive patients. Hence, even though interferon treatment has been reported to promote autoimmunity, the viruses themselves are more likely to induce the appearance of autoimmune markers over time in patients who do not receive treatment.
Collapse
Affiliation(s)
- Daniela Păcurar
- Department of Pediatrics, 'Grigore Alexandrescu' Emergency Children's Hospital, 011743 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Irina Dijmărescu
- Department of Pediatrics, 'Grigore Alexandrescu' Emergency Children's Hospital, 011743 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Dijmărescu
- Department of Radiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Radiology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mirela Pavelescu
- Department of Pediatrics, 'Grigore Alexandrescu' Emergency Children's Hospital, 011743 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihai Andronie
- Department of Economic Sciences, Faculty of Economic Sciences, Spiru Haret University, 030045 Bucharest, Romania
| | - Cristina Becheanu
- Department of Pediatrics, 'Grigore Alexandrescu' Emergency Children's Hospital, 011743 Bucharest, Romania.,Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
4
|
Gilman AJ, Le AK, Zhao C, Hoang J, Yasukawa LA, Weber SC, Vierling JM, Nguyen MH. Autoantibodies in chronic hepatitis C virus infection: impact on clinical outcomes and extrahepatic manifestations. BMJ Open Gastroenterol 2018; 5:e000203. [PMID: 29755758 PMCID: PMC5942460 DOI: 10.1136/bmjgast-2018-000203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/16/2022] Open
Abstract
Goals To examine the role that autoantibodies (auto-abs) play in chronic hepatitis C virus (HCV) regarding demographics, presence of extrahepatic manifestations and long-term outcomes in a large US cohort. Background Auto-abs have been reported to be prevalent in patients with chronic HCV infection, but data on the natural history of these patients are limited. Study The study included 1556 consecutive patients with HCV without concurrent HIV and/or HBV who had testing for antinuclear antibody (ANA), antimitochondrial antibody (AMA), antismooth muscle antibody (ASMA) and/or antiliver kidney microsomal antibody (LKM). Primary outcomes included development of cirrhosis, hepatic decompensations, hepatocellular carcinoma (HCC), mortality and/or sustained virological response (SVR) to antiviral therapy. Results A total of 388 patients tested positive for any auto-ab (ANA 21.8%, ASMA 13.3%, AMA 2.2% and LKM 1.2%). Patients who tested positive versus negative were more likely to be women (29.3% vs 20.9%, p<0.001) and less likely to achieve SVR with most treated patients receiving interferon-based therapies (37.2% vs 47.1%, p=0.031). There was no difference between groups for baseline laboratory data, disease state or rate of extrahepatic manifestations (42.8% vs 45.0%, p=0.44). Kaplan-Meier analysis revealed no statistically significant difference between groups for the 10-year development of cirrhosis, hepatic decompensations, HCC nor survival. Furthermore, auto-ab positivity was only found to be a predictor for a lower rate of SVR on multivariate analysis (adjusted OR=1.61, 95 % CI 1.00 to 2.58, p=0.048). Conclusions In our cohort, auto-ab positivity was common, especially in women, and predicted a lower rate of SVR but otherwise had no impact on the natural history of chronic HCV or presence of extrahepatic manifestations.
Collapse
Affiliation(s)
- Andrew J Gilman
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, ShangHai, China
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - Lee A Yasukawa
- Center for Clinical Informatics, Stanford University, Stanford, California, USA
| | - Susan C Weber
- Center for Clinical Informatics, Stanford University, Stanford, California, USA
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| |
Collapse
|
5
|
Narciso-Schiavon JL, Schiavon LDL. Autoantibodies in chronic hepatitis C: A clinical perspective. World J Hepatol 2015; 7:1074-1085. [PMID: 26052396 PMCID: PMC4450184 DOI: 10.4254/wjh.v7.i8.1074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/16/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chronic carriers of hepatitis C virus (HCV). With respect to endomysial antibodies and tissue transglutaminase, it is controversial whether the prevalence of gluten-related seromarkers is higher in patients with HCV. In such cases, in addition to acknowledging any currently existing autoimmune disease, recognizing the risk of the patient developing an autoimmune disease during interferon (IFN)-based treatment must be a principle concern. From a clinical point-of-view, the presence of autoantibodies arouses suspicion that an autoimmune disease may be present or may be precipitated by IFN-based HCV treatment. In this paper, we review the prevalence of autoantibodies in individuals with hepatitis C, the clinical significance of these autoantibodies, and the approach recommended for such situations.
Collapse
|
6
|
Chen SH, Peng CY, Lai HC, Su WP, Lin CH, Li YF, Chuang PH, Chen CH. An index to predict ribavirin-induced anemia in asian patients with chronic genotype 1 hepatitis C. HEPATITIS MONTHLY 2015; 15:e27148. [PMID: 25834588 PMCID: PMC4377223 DOI: 10.5812/hepatmon.27148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/10/2015] [Accepted: 02/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNP) in the inosine triphosphate pyrophosphatase (ITPA) gene correlate with ribavirin (RBV)-induced anemia in patients with chronic hepatitis C (CHC) receiving combination therapy. Managing anemia is an early priority in the treatment process. OBJECTIVES The aim was to develop a predictive index based on ITPA SNP status to identify CHC patients at risk of anemia. PATIENTS AND METHODS A total of 418 eligible East Asian patients diagnosed with CHC genotype 1 (G1) received combination therapy in this study. Participant DNA was genotyped for a functional ITPA SNP (C/C, A/A or C/A) on chromosome 20 at rs1127354. A predictive index was constructed by incorporating independent factors identified for severe anemia events (hemoglobin < 10 g/dL). Areas under the receiver-operating characteristic curves (AUCs) represented the diagnostic accuracies of the predictive index in randomly assigned development and validation cohorts. RESULTS Multiple logistic regressions identified age (≥ 50 y: OR = 9.7, 95% CI = 5.0 - 18.6), ITPA rs1127354 (C/C: OR = 3.3, 95% CI = 1.8 - 5.8) and baseline hemoglobin (< 14.0 g/dL: OR 6.4, 95% CI = 3.3 - 12.1; 14.0 - 14.9: OR = 2.4, 95% CI = 1.2 - 4.6) as predictors of severe anemia throughout the treatment. For severe anemia, the predictive index incorporating age, ITPA SNP status and baseline hemoglobin yielded diagnostic accuracies (AUCs) of 0.830 (95% CI = 0.783 - 0.871) in the development (n = 324) and 0.902 (0.826 - 0.925) in the validation (n = 81) cohorts. CONCLUSIONS In patients with CHC G1 and receiving combination therapy, ITPA SNP-based index was an accurate and practical solution for prediction of severe anemia.
Collapse
Affiliation(s)
- Sheng-Hung Chen
- Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- School of Medicine, China Medical University, Taichung, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Corresponding Author: Cheng-Yuan Peng, Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taiwan. Tel: +88-6422052121, E-mail:
| | - Hsueh-Chou Lai
- Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Pang Su
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hsin Lin
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Fen Li
- Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Po-Heng Chuang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Hsiang Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
7
|
Anti-nuclear antibody detection in cryoprecipitates: distinctive patterns in hepatitis C virus-infected patients. Dig Liver Dis 2015; 47:50-6. [PMID: 25445409 DOI: 10.1016/j.dld.2014.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/02/2014] [Accepted: 09/13/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anti-nuclear antibodies are immunoglobulins directed against nuclear antigens. They are associated with many autoimmune disorders, but are frequently found in patients infected with hepatitis C virus, possibly indicating an underlying common origin. Likewise, mixed cryoglobulinemia often accompanies autoimmune diseases and hepatitis C infection. AIM To compare anti-nuclear antibodies and immunoglobulin content of cryoprecipitates from hepatitis C virus-positive patients in order to assess their predictive value in the onset of hepatitis C virus-driven extrahepatic disorders. METHODS Serum from 40 hepatitis C virus-positive patients and 50 controls with rheumatoid arthritis was processed for cryoglobulin detection: all subjects presented with Type III mixed cryoglobulinemia. Immunoglobulin content and immunoglobulin subclasses of cryoprecipitates were assessed by immunofixation and tested by ELISA for rheumatoid factor. Cryoprecipitates were also analysed for anti-nuclear antibodies by indirect immuno-fluorescence to identify specific patterns typical of each condition. RESULTS Anti-nuclear antibody patterns differed significantly; 26 infected subjects (65%) were IgG3 positive: of these, 25 were also anti-nuclear antibody-positive (96.1%). CONCLUSIONS IgG3 are autoreactive clones unrelated to viral recognition and possibly involved in autoimmune disorders. Altogether, these results may represent useful diagnostic device for early detection of hepatitis C virus-induced autoimmune diseases.
Collapse
|
8
|
Yang DH, Ho LJ, Lai JH. Useful biomarkers for assessment of hepatitis C virus infection-associated autoimmune disorders. World J Gastroenterol 2014; 20:2962-2970. [PMID: 24659887 PMCID: PMC3961981 DOI: 10.3748/wjg.v20.i11.2962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/10/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestations of autoimmune disorders may occur, including arthralgia/arthritis, sicca complex, purpura, cutaneous ulcer, and thyroid dysfunction. In addition, the prevalence of circulating autoantibodies is high among patients with HCV infection. Commonly detected autoantibodies in HCV-infected patients include rheumatoid factor, antinuclear antibody, anti-SSA/anti-SSB antibody, cryoglobulin, antineutrophil cytoplasmic antibody, anti-smooth muscle antibody, anti-liver and anti-thyroid autoantibodies. These autoantibodies may be associated with underlying autoimmune disorders or liver inflammation in HCV infection. A possible reason for antibody production is overactivation and proliferation of B lymphocytes, via the interaction with the surface protein of HCV. Because immunotherapy can cause HCV flare-up or liver damage, overdiagnosis of HCV-related autoimmune symptoms as primary autoimmune disorders should be avoided. This review describes biomarkers that are useful in clinically evaluating autoimmune manifestations and disorders associated with HCV infection.
Collapse
|
9
|
Khairy M, El-Raziky M, El-Akel W, Abdelbary MS, Khatab H, El-Kholy B, Esmat G, Mabrouk M. Serum autoantibodies positivity prevalence in patients with chronic HCV and impact on pegylated interferon and ribavirin treatment response. Liver Int 2013; 33:1504-9. [PMID: 23763380 DOI: 10.1111/liv.12227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/01/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Prevalence of serum autoantibodies in chronic hepatitis C (HCV) patients is higher than that in the general population. Interferon may induce autoimmune manifestations in patients treated with peg-interferon and ribavirin. Effect of autoantibody seropositivity and treatment response are limited and controversial. To detect the prevalence of serum autoantibodies in patients with chronic HCV and impact on histopathology and treatment response. METHODS Retrospective study including 3673 Egyptian chronic HCV naïve patients enrolled in the Egyptian national programme for HCV treatment with pegylated interferon and ribavirin in the years 2007-2010. Antinuclear antibody (ANA) was determined by ELISA considered positive with a titre ≥ 1:40 by indirect immunofluorescence. ANA-positive patients pre treatment workup including serum aminotransferases, thyroid profile and liver biopsy, follow-up during treatment and sustained virological response (SVR) were assessed compared to ANA-negative patients. RESULTS Serum ANA was positive in 1.6% of the studied patients. There were no statistically significant differences concerning the demographic, biochemical and histopathological data in ANA positive and negative patients. SVR was comparable between ANA-positive and ANA-negative patients (67.8% and 61.3% respectively). Follow-up treatment; ANA-positive patients' did not experience statistically significant haematological complications, flare-up of serum transaminases, thyroid dysfunction. No systemic autoimmune disorders developed during follow-up. CONCLUSIONS ANA positivity is not a factor in chronic HCV disease progression and does not affect the treatment response. Pegylated interferon and ribavirin therapy is safe and effective in autoantibodies-positive chronic HCV patients with no need for further follow-up or worry during the treatment in absence of systemic autoimmune disorders.
Collapse
Affiliation(s)
- Marwa Khairy
- Endemic Medicine and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Combination therapy with pegylated interferon and ribavirin is the standard of care (SOC) for the treatment of chronic hepatitis C (CHC). Treating CHC with SOC may show a sustained virological response (SVR) in approximately 50-70 % of genotype 1 CHC patients and an SVR in 70-90 % of genotype 2 CHC patients. The genotype, baseline viral load, and viral kinetics (i.e., rapid virologic response and early virologic response) can be used as predictors of response-guided therapy. Nonetheless, host factors, e.g. age, ethnicity, insulin resistance, and genetic variations, may also play important roles in the SVR in CHC patients treated with SOC. Recent genome-wide association studies have demonstrated that single-nucleotide polymorphisms near the interleukin 28B gene (IL28B) were associated with SVR to treatment with SOC in CHC patients. The IL28B polymorphisms may contribute to the viral kinetics during treatment. Asian people have favorable IL28B polymorphisms. This factor may at least partly explain the high eradication rate of hepatitis C by SOC in Asia. Combination therapy with direct-acting antivirals (DAAs) and SOC can increase the SVR rates both in treatment-naïve and treatment-experienced patients. Although the IL28B polymorphisms also affect the SVR of triple therapy with SOC and first-generation protease inhibitors, pilot studies have demonstrated that potent DAAs might overcome the influence of IL28B polymorphisms. Thus, the treatment of hepatitis C virus infection could be simplified in the near future.
Collapse
Affiliation(s)
- Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung, Taiwan.
| | | |
Collapse
|