title: Incidence and antiviral response of hepatitis C virus reactivation in lupus patients undergoing immunosuppressive therapy.
abstract: OBJECTIVE
  Systemic lupus erythematosus (SLE) is a systemic autoimmune disease and usually requires immunosuppressive therapy, which is a major cause of viral reactivation. The incidence and antiviral response in SLE patients with hepatitis C virus (HCV) reactivation is unclear and needs to be investigated.
  
  
  METHODS
  One hundred and sixty-six SLE patients with antibody to HCV (anti-HCV) status were retrospectively reviewed regarding the events of HCV reactivation. Patients with HCV reactivation were treated with pegylated interferon plus ribavirin treatment. The virological response and relapse rate were evaluated.
  
  
  RESULTS
  Twenty-six patients were positive for anti-HCV. During a mean 8.4 years of follow-up, 10 (38.5%) cases developed HCV reactivation. No clear relationship was noted between immunosuppressive therapy and the HCV reactivation. Eight patients underwent antiviral therapy and the rapid virological response (RVR), early virological response, and sustained virological response (SVR) rates were 37.5%, 87.5%, and 75.0%, respectively. However, late relapse (reappearance of HCV RNA in serum after archiving SVR) was found in two (33.3%) of six patients achieving SVR. The two cases were HCV genotype 1 b concurrent with corticosteroid treatment.
  
  
  CONCLUSIONS
  HCV reactivation in anti-HCV-positive SLE patients was possibly associated with glucocorticoids. The virological response to interferon plus ribavirin treatment is not inferior to the general population. However, monitoring HCV RNA after SVR is necessary for patients concurrent with corticosteroid treatment due to the risk of late relapse.
authors.affiliation: Division of Allergy-Immunology-Rheumatology Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Hematology.
authors.forename: M-H
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Division of Allergy-Immunology-Rheumatology Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Tsai
authors.affiliation: Division of Allergy-Immunology-Rheumatology Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-T
authors.initials: CT
authors.lastname: Chou
authors.affiliation: Division of Allergy-Immunology-Rheumatology Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Division of Allergy-Immunology-Rheumatology Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: D-F
authors.initials: DF
authors.lastname: Huang
authors.affiliation: Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan yhhuang@vghtpe.gov.tw dfhuang@vghtpe.gov.tw.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D016174:Hepacivirus / Q000502:physiology*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D016898:Interferon-alpha / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D019562:Viral Load / Q000187:drug effects; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D012254:Ribavirin
keywords: HCV reactivation; Systemic lupus erythematosus; immunosuppression; interferon; late relapse; virological response