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Is autoimmune chronic active hepatitis a HCV-related disease?
S Magrin1, A Craxì, G Fiorentino
1Clinica Medica R, University of Palermo, Italy.
Journal of Hepatology
|July 1, 1991
Summary
In autoimmune hepatitis, anti-hepatitis C virus (HCV) antibody positivity was evaluated. False positives were noted in severe cases, suggesting RIBA-negative patients may have true autoimmune chronic active hepatitis.
Area of Science:
- Hepatology
- Immunology
- Virology
Background:
- Autoimmune chronic active hepatitis (ACH) can be challenging to differentiate from viral hepatitis.
- Patients with ACH often exhibit autoantibodies, including anti-nuclear and anti-liver-kidney microsomal antibodies.
- Hepatitis C virus (HCV) infection can also cause chronic hepatitis, and serological tests are used for diagnosis.
Purpose of the Study:
- To assess the specificity and clinical significance of anti-HCV antibody positivity in HBsAg-negative patients with autoimmune chronic active hepatitis.
- To investigate the correlation between anti-HCV test results and disease severity and treatment response.
- To differentiate true autoimmune hepatitis from potential HCV co-infection or false-positive serology.
Main Methods:
- Evaluated 22 HBsAg-negative patients with autoimmune chronic active hepatitis.
- Utilized Enzyme-Linked Immunosorbent Assay (ELISA) for anti-HCV antibody detection.
- Employed Recombinant Immunoblot Assay (RIBA-HCV) to confirm ELISA results.
- Assessed histologic necroinflammation, AST/ALT levels, and gamma-globulin levels.
- Monitored response to prednisolone treatment.
Main Results:
- 59% of patients were positive for anti-HCV by both ELISA and RIBA-HCV.
- 23% were negative by both tests.
- 18% had borderline ELISA results, with 3 severe cases being RIBA-negative.
- RIBA anti-HCV-negative patients exhibited higher necroinflammation, AST/ALT, and gamma-globulin levels.
- RIBA anti-HCV-negative patients showed a better response to prednisolone treatment.
Conclusions:
- Confirmed a high prevalence of anti-HCV positivity in autoimmune chronic active hepatitis patients, as previously suggested by ELISA.
- False positive anti-HCV results (ELISA positive, RIBA negative) were observed primarily in patients with severe disease.
- RIBA-negative patients with autoimmune chronic active hepatitis may represent a distinct subset with a 'true' autoimmune etiology, showing better corticosteroid responsiveness.