Journal Article

Clinical Impact of Non—Organ-Specific Autoantibodies on the Response to Combined Antiviral Treatment in Patients with Hepatitis C

Paolo Muratori, Luigi Muratori, Marcello Guidi, Alessandro Granito, Micaela Susca, Marco Lenzi and Francesco B. Bianchi

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 4, pages 501-507
Published in print February 2005 | ISSN: 1058-4838
Published online February 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/427285
Clinical Impact of Non—Organ-Specific Autoantibodies on the Response to Combined Antiviral Treatment in Patients with Hepatitis C

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Background. Hepatitis C virus (HCV)—related chronic hepatitis is frequently associated with non—organ-specific autoantibodies (NOSAs), but available data about the relationship between NOSA positivity and the effect of antiviral therapy in persons with hepatitis C are few and controversial. Our aim was to evaluate the impact of NOSA positivity on the outcome of combined antiviral therapy in HCV-positive patients.

Methods. A total of 143 consecutive adult patients with hepatitis C were studied. Antinuclear antibody (ANA), anti—smooth muscle antibody (SMA), and anti—liver/kidney microsomal antibody type 1 (LKM1) were detected by indirect immunofluorescence. All patients were treatment naive and received combined antiviral therapy (interferon [IFN]—ribavirin) after enrollment in the study. Patients were classified as nonresponders if HCV RNA was detectable after 6 months of therapy, as relapsers if abnormal transaminase levels and reactivation of HCV replication were observed after the end of treatment, and as long-term responders if transaminase levels were persistently normal and HCV RNA was undetectable 6 months after the end of treatment.

Results. Thirty-seven patients (25%) were NOSA positive (SMA was detected in 19 patients, ANA in 10, ANA and SMA in 4, LKM1 in 3, and SMA and LKM1 in 1). The prevalence of long-term response was similar between NOSA-positive patients and NOSA-negative patients (48.6% vs. 56.6%; P = not significant). Compared with HCV genotype 1 (HCV-1), HCV genotypes other than 1 were more often associated with long-term response among NOSA-positive patients (93.3% vs. 30%; P = .0017). The overall rate of long-term response, irrespective of NOSA status, was 54.5%. Detection of HCV-1 and elevated γ-glutamyl transpeptidase serum levels were independent negative prognostic factors of treatment response (P = .007 and P = .026, respectively).

Conclusions. Combined antiviral treatment (IFN-ribavirin) is safe and effective in NOSA-positive patients with hepatitis C, even if long-term response is less likely in those infected with HCV-1.

Journal Article.  3574 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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