Clinical features and effect of antiviral therapy on anti-liver/kidney microsomal antibody type 1 positive chronic hepatitis C.
OBJECTIVE
Anti-liver/kidney microsomal antibody type 1 (anti-LKM1), a serological marker of type 2 autoimmune hepatitis, is also detected in a small proportion of patients with hepatitis C. This study aimed to evaluate clinical features and effect of antiviral therapy in patients with hepatitis C who are anti-LKM1 positive.


METHODS
Sixty consecutive anti-LKM1 positive and 120 age and sex-matched anti-LKM1 negative chronic hepatitis C patients were assessed at diagnosis and during follow-up. Of these, 26 anti-LKM1 positive and 72 anti-LKM1 negative received antiviral therapy. Anti-LKM1 was detected by indirect immunofluorescence and immunoblot. Number of HCV-infected hepatocytes and intrahepatic CD8+ lymphocytes was determined by immunohistochemistry.


RESULTS
At diagnosis anti-LKM1 positive patients had higher IgG levels and more intrahepatic CD8+ lymphocytes (p 0.022 and 0.046, respectively). Viral genotypes distribution and response to therapy were identical. Hepatic flares during antiviral treatment only occurred in a minority of patients in concomitance with anti-LKM1 positivity.


CONCLUSIONS
Immune system activation is more pronounced in anti-LKM1 positive patients with hepatitis C, possibly representing the expression of autoimmune mechanisms of liver damage. Antiviral treatment is as beneficial in these patients as in anti-LKM1 negative patients, and the rare necroinflammatory flares are effectively controlled by corticosteroids, allowing subsequent resumption of antiviral therapy.
Ferri
Silvia
S
Department of Clinical Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. silvia.ferri9@unibo.it
Muratori
Luigi
L
Quarneti
Chiara
C
Muratori
Paolo
P
Menichella
Rita
R
Pappas
Georgios
G
Granito
Alessandro
A
Ballardini
Giorgio
G
Bianchi
Francesco B
FB
Lenzi
Marco
M
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology / Q000821:virology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007372:Interferons / Q000627:therapeutic use; D007668:Kidney / Q000276:immunology; D008099:Liver / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D008297:Male; D008861:Microsomes / Q000276:immunology; D008875:Middle Aged; D012254:Ribavirin / Q000627:therapeutic use; D055815:Young Adult
D000998:Antiviral Agents; D001323:Autoantibodies; D007074:Immunoglobulin G; C060729:anti-liver kidney microsome antibody; D012254:Ribavirin; D007372:Interferons; D000410:Alanine Transaminase