HIGH PREVALENCE OF SEROLOGICAL MARKERS OF AUTOIMMUNITY IN PATIENTS WITH CHRONIC HEPATITIS-C

The advent of specific antiviral therapy for chronic hepatitis C has increased the importance of establishing the correct etiology of chronic hepatitis in patients, especially because interferon alfa (IFN-alpha) has been reported to exacerbate autoimmune hepatitis (AIH), whereas corticosteroids increase viral replication in chronic hepatitis C. In our medical center, we have treated many patients with apparent chronic hepatitis C and serological or clinical evidence of autoimmunity. Our aim was to estimate the prevalence of this association and to learn whether demographic or clinical features distinguished between patients with of without autoimmune markers, We performed a retrospective review of the records of 244 unselected patients seen at the Clinics and Hospital of the University of Massachusetts between May 1991 and November 1993, who had elevated serum aminotransferases, One hundred seventeen patients had chronic hepatitis C defined by elevations of serum alanine transaminase (ALT) for at least 6 months, positive serum antibodies to hepatitis C virus (HCV; second-generation enzyme immunoassay [EIA2] or recombinant immunoblot assay [RIBA]), and absence of hepatitis B surface antigen in the serum. Records were reviewed for results of autoimmune markers in sera, including anti-nuclear antibodies (ANAs), anti-smooth muscle antibodies (SMAs), rheumatoid factor (RF), antimitochondrial antibodies (AMAs), anti-liver and kidney microsomal (LKM) antibodies, and cryoglobulins, We found a high prevalence of positivity, particularly for anti-SMAs (66%) and RF (76%) in both men and women, Forty of 41 patients tested negative for anti-LKM antibodies, There were no significant differences in age, gender, severity of hepatitis, or response to IFN between those who were positive for autoimmune markers and those who were not. None of the patients treated with IFN developed clinical manifestations of autoimmune disease. We conclude that markers of autoimmunity occur with high and equal frequency in men and women with chronic hepatitis C, Their presence should not preclude therapy with IFN, which often improves hepatitis and features of autoimmune disease in patients with both.