NON-ORGAN-SPECIFIC AUTOANTOBODIES IN CHRONIC HEPATITIS C. CLINICAL SIGNIFICANCE AND IMPACT ON TREATMENT WITH INTERFERON AND RIBAVARIN

Abstract

Purpose: Non-organ-specific auto-antibodies (NOSA) like antinuclear antibody (ANA) and antismooth muscle antibody (SMA), which are well recognized, as diagnostic markers of type 1 autoimmune hepatitis, are frequently associated with chronic hepatitis C infection. The interpretation of these autoimmune markers is highly important for proper decision making in therapy as interferon therapy leads to exacerbation of autoimmune hepatitis while corticosteroids enhance viral replication in patients with chronic hepatitis C. The aim of our study was to evaluate whether the presence of these NOSA in a cohort of HCV infected patients influenced their response to treatment with INF + ribavarin and also to compare the clinical, biochemical and histological profile of HCV related disease in auto-antibody positive and auto-antibody negative patients. Methods: This was a retrospective chart review of chronic hepatitis C patients who were treated with a combination therapy of INF + ribavarin or Pegylated INF + ribavarin. 85 patients were selected based on the inclusion and exclusion criteria. The auto-antibodies studied were ANA, ASMA, AMA; a significant titer of each was 1:40 or higher. There were 16 patients positive for at least one of these antibodies. These patients were matched to 42 auto-antibody negative patients for factors proven to predict response to treatment such as HCV genotype, viral load, and inflammation and fibrosis scores on liver biopsy. Results: There were no statistically significant differences between the two groups in demographics orbiochemical profiles. No difference was observed in genotype, viral load or liver biopsies as they were well matched prior to comparison. There was a trend towards a low sustained viral response (SVR) in the auto-antibody positive group (6.2%) as compared to the auto-antibody negative group (3 8%) though this was not statistically significant. One patient in the antibody positive group had a precipitous rise in transaminases soon after initiation of treatment. Conclusions: We conclude that though the presence of auto-antibodies does not preclude treatment with INF and ribavarin, each patient needs careful evaluation to exclude autoimmune hepatitis and requires individualized management. Although the response rate to combination therapy was not significantly different between the two groups, there was a trend towards low SVR in the antibody positive group suggesting the presence of NOSA might reduce the long-term response to combination therapy.