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CLINICAL REVIEW: Kathryn L Nash, Ian Bentley, and Gideon M Hirschfield Managing hepatitis C virus infection BMJ 2009; 338: b2366 [Full text]

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Treatment of Hepatitis C and autoimmunity.

Moulinath Banerjee   (4 July 2009)

Treatment of Hepatitis C and autoimmunity. 4 July 2009
Moulinath Banerjee, Specialist Registrar & Hon. Clnical Research Fellow Manchester Royal Infirmary Send response to journal: Re: Treatment of Hepatitis C and autoimmunity.	Dear Editor I read with great interest the article ‘Managing hepatitis C virus infection’ by Nash et al in this week’s BMJ1. It was a pleasant read and was nice to see that the authors have taken great pain to address almost all the major aspects of management of Hepatitis C infection. The only significant area which has been omitted by the authors has been the induction of autoimmune disorders by alpha-interferon therapy. It is a well known fact that Hepatitis C infection itself is associated with increased incidence of autoimmune disorders2;3. The risk of autoimmune disorders increase with alpha-interferon therapy and more so when combined with Ribavirin4. The auto-immunity seen includes both organ specific and non- specific forms5;6. The organ which is most commonly affected and therefore studied is the thyroid gland7. Though the exact mechanism of induction of autoimmunity is not known, the plausible hypotheses includes enhanced CD-95 expression in CD-4 and CD-8 T lymphocytes8, CD-81 overexpression in B lymphocytes9 and HLA subtype predisposition10. Most of the autoimmunity improves considerably after treatment with alpha- interferon has been stopped11. Hence, exclusion of this aspect of complication of treatment of hepatitis C infection was too glaring to ignore. Thanking you Reference List (1) Nash KL, Bentley I, Hirschfield GM. Managing hepatitis C virus infection. BMJ 2009; 338(jun26_1):b2366. (2) Ozdemir FN, Turan M, Sezer S, Kayatas M, Haberal A, Guz G et al. Prevalence of serological markers of autoimmunity in hemodialysis patients with hepatitis C virus. Transplant Proc 1998; 30(3):848-849. (3) Clifford BD, Donahue D, Smith L, Cable E, Luttig B, Manns M et al. High prevalence of serological markers of autoimmunity in patients with chronic hepatitis C. Hepatology 1995; 21(3):613-619. (4) Carella C, Mazziotti G, Morisco F, Rotondi M, Cioffi M, Tuccillo C et al. The addition of ribavirin to interferon-alpha therapy in patients with hepatitis C virus-related chronic hepatitis does not modify the thyroid autoantibody pattern but increases the risk of developing hypothyroidism. Eur J Endocrinol 2002; 146(6):743-749. (5) Gatselis NK, Georgiadou SP, Koukoulis GK, Tassopoulos N, Zachou K, Liaskos C 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(11-12):1563-1573. (6) Yoshikawa M, Sakamoto T, Mitoro A, Mochi T, Tsujii H, Koizumi M et al. Autoimmunity during alpha-interferon therapy for chronic hepatitis C. Gastroenterol Jpn 1993; 28 Suppl 5:109-114. (7) Murdolo G, Francisci D, Forini F, Baldelli F, Angeletti G, Stagni G et al. Expression of endocrine autoantibodies in chronic hepatitis C, before and after interferon-alpha therapy. J Endocrinol Invest 2002; 25(11):938-946. (8) Ogawa S, Sakaguchi K, Takaki A, Shiraga K, Sawayama T, Mouri H et al. Increase in CD95 (Fas/APO-1)-positive CD4+ and CD8+ T cells in peripheral blood derived from patients with autoimmune hepatitis or chronic hepatitis C with autoimmune phenomena. J Gastroenterol Hepatol 2000; 15(1):69-75. (9) Zuckerman E, Slobodin G, Kessel A, Sabo E, Yeshurun D, Halas K et al. Peripheral B-cell CD5 expansion and CD81 overexpression and their association with disease severity and autoimmune markers in chronic hepatitis C virus infection. Clin Exp Immunol 2002; 128(2):353-358. (10) Floreani A, Chiaramonte M, Greggio NA, Fabris P, De Lazzari F, Naccarato R et al. Organ-specific autoimmunity and genetic predisposition in interferon-treated HCV-related chronic hepatitis patients. Ital J Gastroenterol Hepatol 1998; 30(1):71-76. (11) Carella C, Mazziotti G, Morisco F, Manganella G, Rotondi M, Tuccillo C et al. Long-term outcome of interferon-alpha-induced thyroid autoimmunity and prognostic influence of thyroid autoantibody pattern at the end of treatment. J Clin Endocrinol Metab 2001; 86(5):1925-1929. Competing interests: None declared