Results of steroid-based therapy for the hepatitis C-autoimmune hepatitis overlap syndrome.
OBJECTIVE
Overlap syndromes in which persons manifest clinical, histological, or immunological features of both hepatitis C infection and autoimmune hepatitis are well described. The discordant forms of treatment for hepatitis C and autoimmune hepatitis have made medical management of these patients difficult. We report our experience in using corticosteroids as first line therapy for the hepatitis C-autoimmune hepatitis overlap syndrome.


METHODS
Seven patients with this overlap syndrome (diagnosis based on the presence of serum hepatitis C antibody by RIBA and serum hepatitis C RNA by polymerase chain reaction, and serum hypergammaglobulinemia, elevated ANA or ASMA titers, or histological findings consistent with autoimmune hepatitis) were treated with prednisone with or without azathioprine or cyclosporine, and followed for a median duration of 44.5 months.


RESULTS
Five patients (71%) showed improvement of median serum ALT level from 162 U/L to 38 U/L (p = 0.04) and median serum gamma-globulin from 2.1 g/dl to 1.4 g/dl (p = 0.04) by 6 months of therapy. The mean modified histological activity index score also decreased from 11.4 +/- 2.5 to 6.6 +/- 2.6 (p = 0.04) by at least 1 yr of therapy. One patient discontinued prednisone while taking azathioprine and experienced a rebound elevation of serum ALT that did not respond to retreatment with prednisone. Antiviral therapy was subsequently administered and resulted in biochemical and virologic response. Hepatitis C virus RNA remained detectable in all other patients.


CONCLUSIONS
Corticosteroids are beneficial as a first line therapy for some patients with the hepatitis C-autoimmune overlap syndrome, resulting in appreciable biochemical and histological response but without viral eradication.
Schiano
T D
TD
Department of Medicine, The Mount Sinai Medical Center, New York, New York 10029-6574, USA.
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H S
HS
Thomas
R M
RM
Hussain
H
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Bond
K
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Black
M
M
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D006508:Hepatitis Antibodies / Q000097:blood; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D013577:Syndrome
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D001323:Autoantibodies; D005938:Glucocorticoids; D006508:Hepatitis Antibodies; D007166:Immunosuppressive Agents; D007372:Interferons; D011241:Prednisone