Interferon therapy in liver/kidney microsomal antibody type 1-positive patients with chronic hepatitis C.
The association between liver/kidney microsomal antibody type 1 and adult cases of hepatitis C virus-related chronic liver disease has been firmly established. In the presence of both markers, evidence of autoimmunity (liver/kidney microsomal antibody type 1) and actual viremia (serum HCV RNA), the therapeutic dilemma arises between steroids, which are beneficial to autoimmune but deleterious to viral diseases, and interferon-alpha, which may exacerbate an autoimmune disorder. Six patients with liver/kidney microsomal antibody type 1 and serum HCV RNA were given interferon-alpha: three showed a response pattern similar to that observed in autoantibody-negative chronic hepatitis C cases; the other three developed a sharp transaminase peak, which was not followed by HCV RNA clearance. Considering the brisk flare-up of liver cell necrosis, interferon-alpha treatment proved to be dangerous in the above three liver/kidney microsomal antibody type 1/HCV RNA positive cases. Subsequent steroid administration reduced alanine aminotransferase peaks, but may be harmful in viral infections. Therapeutic alternatives are needed: they will probably include pure antivirals (exerting no immunostimulatory effects) with or without immunosuppressive drugs.
Muratori
L
L
Cattedra di Medicina Interna 1, Università di Bologna, Policlinico S. Orsola, Italy.
Lenzi
M
M
Cataleta
M
M
Giostra
F
F
Cassani
F
F
Ballardini
G
G
Zauli
D
D
Bianchi
F B
FB
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis*; D002908:Chronic Disease; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis / Q000097:blood / Q000235:genetics
D001323:Autoantibodies; D016898:Interferon-alpha; D012367:RNA, Viral; C060729:anti-liver kidney microsome antibody; D000410:Alanine Transaminase