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Autoantibody prevalence in children with liver disease due to chronic hepatitis C virus infection
186 VIRAL HEPATITIS: CLINICAL ASPECTS pi%Gi-j
1 CO6/003
AUTOANTIBODY PREVALENCE IN CHILDREN WITH LIVER DISEASE DUE TO CHRONIC HEPATITIS C VIRUS INFECTION
A COMMUNITY BASED SURVEY OF HCV INFECTION IN THE GENERAL POPULATIONOF A GREEK ISLAND .. . . ..I . ‘+ C.GoritsaaLPlerou**.S.~D.Vel~~
GVGreeorio’,2. PPensati’. RIorio’. AVeanente3. GMieli-Vereani’, DVerganir ‘Inst of Hepatology Univ College London; *Child Health King’s College London: ‘Dipartimento di Pediattia, Univ di Napoli, Italia
Internal Medicine Dept. Hospital of Patras,*Intemal Medicine Dopond l *Tmnsti&m VI& of Gene&l Ho&al of Zakinthos, Greece.
HepatitisC virns(HCV) infectionand interferonalpha(IFN-a) therapy have been associated with autoimmumty. To assess whether chronic liver disease (CLD) due to HCV infection or its treatment with IFN-(r cause autoimmune manifestations, we analysed the prevalence of tissue autoantibodies in 51 children with chronic HCV infection and 84 with other CLD by standard techniques. 65% of patients with chronic HCV infection, 66% with chronic hepatitis B infection and 60% with Wilson’s disease were positive for at least one autoantibody. In the 51 subjects with chronic HCV infection (29 treated with IFN-o, 22 untreated), tested on 165 occasions over a median of 9 months (range: 5-42), autoantibodies to nuclei (ANA), smooth muscle (SMA), gastric parietal cell (GPC) and/or liver kidney microsomal type 1 (LKMl) were similarly prevalent in treated and untreated patients [88 % vs 68 %, P=O. 121. Positivity for SMA was present in 67%. GPC in 32%. ANA in 101, LKMl in 8% of cases. Treatment with IFN-CYhad to be suspended due to transaminase elevation in 1 SMA positive, 1 ANA positive but in three of four LKMl positive patients. Our results show that: (1) autoantibodies are common in viralinduced hepatitis and Wilson’s disease; (2) positivity for SMA, GPC, ANA is associated with chronic HCV infection, their prevalence being unaffected by IFN-(r; (3) IFN-o should be used cautiously in the treatment of LKMl/HCV positive patients.
1 CO6/002
1
GBV-UHGV INFECTION: A FAVOURABLEPRGGNGSTIC FACTOR lN HIV INFECTED PATIENTS?
Immunology, Madizinische Hochschule Hannover, Garmany. To Investigate a possible influcnco of GB vbus-C (GBV-C) In inununocompromised patients, we studied the prevalences of GBV-C RNA (RT-PCR of the S’UTR) and anti-E2 antibody (EIA) in 197 HIV in&ted patients and in 120 control blood donors. With respect to the GBV-C status we difkentiatcd viremic (GBV-C RNA positive), exposed (anti E2 positivc/GBV-C RNA negative) and not exposed HIV patients (anti E2 nagative/GBV-C RNA negative).GBV-C RNA was detected in 331197HIV inkted patients (16.8%) compared to one in 120 blood donors (0.8%) (p~O.001).Previous expomue to GBV-C (anti E2+) was shown in 56,8% of HIV pationts and in 9% of blood ders. Only 52 HIV patients (26,4%) had no markers of GB,V-C infection. Viremia of GBV-C was not associated with hepatitis. Despite of approximately equal duration of HIV infkction in all subgroups, the CD4 co+s were signikantly higher in GBV-C viremic HIV patients (344 cells/~l) compared to exposad (259 cells/~l) and to not exposed patients (170 colls/pl) (p = .017 and p < .OOl). Furthem~re, Kaplan-M&r analysis demonstrated significantly hotter cumulative survival in GBV-C RNA positive HIV patients, suggesting that GBV-C might be a fivourable prognostic factor in HIV disease.
1
Although anti-HCV prevalence in blood donors in Greece is low (0,2-0,40/o), epidemiologic characteristics of HCV infktion in the general population have not been enough shulied.The objective ofthis shrdy was to examine the seropmalenceofHCVi&ctionaadamc&tedriskfactorsinthegeneral popuhtionofZskinthoqaGreckislandinthehiansedwitham&dehed mixed (urban and rural) popohtion. ~:Ahouseboldbealthsurveywascarriedoutinaraodomlyselected sampleof 718 adults (228 urban and 490 roral).A questionnaire was completedandbloodsamplewasobtahedthnallparticipants.Sexum samples were tested for anti-HCV antibodieaby third genuntion ELISA and supplementaltest(Abbot).The hfhxaux of PC characteristics, healthaotewhtsandpossiileassociatcdriskfaaorsontheeeroprevalence of HCV was imw&ted by logistic regrehn analyak. m:The overall anti-HCV prevalence was 1,8%(ud?anpopulation 0,90/r rural 2,25% non sign&ant [email protected] hi&x seroprevahe was hod inmalepopohtion(2.8%vs l.l5%inkmsle)buttheditkewwasnot signiflcant.Tlyewasatrendoficreashgprwalenccwith~,witha signi6~ d&rew(@,oo2) between the age groups 15-44(0%)and over 45 (3, I%).Tbe lo&tic regrehm amdysiscolhmed asi&kantasso&tion behveen anti-HCV positivity and:l)hcrea@ aee(p
pop&ion, indicates that HCV serolnwalence(l.8%) is nmch hi&x than that of blood donors(O,36%in Zakinth).The heasiag prevalence with ageandtheawciationwithpanotarlexposweindicatesthatHCV infectioncanmainlybeattriiedto parenteraltechnicainthepast.
1 CO6/004
1
THYROID TESTS IN PATIENTS WITH HEPATITIS C BEFORE AND DURING lNTERFERON (IFN) a THERAPY -i* E R&&i III Dept. of Internal Medicine, * III Laboratory, Hospital of Brescia, Italy Autoimmune thyroiditis has been reported in patients with chronic hepatitis C, and IFN therapy may be a cause of thyroid dysfunction. We studied 164 patients with chronic hepatitis C (70 M and 94 F, age 51.8k11.5 yrs), 4 with chronic portal hepatitis, 142 with chronic interface hepatitis, and 18 with cirrhosis. IFN a was administered to 108 patients (53 M and 55 F, age 50.7+10.9 yrs) at a dosage of 3 MU 3 times a week (TIW) (n. 44) or 5 MU TIW (n. 64) for 4 months. Responders then received 3 MU TIW for further 8 months. FI3, Fl4, TSH, anti-thyroid peroxidase (TPAb) and anti-thyroglobulin (TGAb) antibodies were determined at baseline and during therapy, every 4 months. Treatment was not considered or suspended in the presence of abnormal thyroid tests. At baseline, subclinical hypothyroidism (increased TSH with normal IT3 and FT4 levels) was detected in 7 F patients, 1 with TPAb, 1 with TGAb and 2 with both. TPAb were found in 4 additional patients (2 M and 2 F) and TGAb in 1 (M). During treatment, subclinical hypothyroidism developed in 4 patients, after 4 (n. 3, 2 M and 1 F) or 8 (n. 1, F) months of treatment. TPAb were detected in 5 patients with normal TSH, after 4 (n. 2, 1 M and 1 F), 8 (n. 2, 1 M and 1 F) or 12 (n. 1, M) months. TGAb were detected in 3 patients with normal thyroid function, after 4 (n. l), 8 (n. 1) or 12 (n. 1) months of treatment. Two of these patients also had TPAb. Abnormal thyroid tests were detected in 7/44 patients starting treatment with 3 MU IFN TIW and in 4/64 patients starting treatment with 5 MU. Clinical hypothyroidism developed in 1 patient treated with 3 MU for 12 months, but thyroid function spontaneously recovered 6 months after IFN discontinuation. Altogether, abnormal thyroid tests were present in 12/164 patients (7.3%, 10 F and 2 M) at baseline and appeared in 111108 patients (10 %, 5 F and 6 M) during treatment. The appearance of thyroid dysfunction and/or autoantibodies during treatment does not seem related to sex or to schedule and duration of treatment.
1 CO6/003
AUTOANTIBODY PREVALENCE IN CHILDREN WITH LIVER DISEASE DUE TO CHRONIC HEPATITIS C VIRUS INFECTION
A COMMUNITY BASED SURVEY OF HCV INFECTION IN THE GENERAL POPULATIONOF A GREEK ISLAND .. . . ..I . ‘+ C.GoritsaaLPlerou**.S.~D.Vel~~
GVGreeorio’,2. PPensati’. RIorio’. AVeanente3. GMieli-Vereani’, DVerganir ‘Inst of Hepatology Univ College London; *Child Health King’s College London: ‘Dipartimento di Pediattia, Univ di Napoli, Italia
Internal Medicine Dept. Hospital of Patras,*Intemal Medicine Dopond l *Tmnsti&m VI& of Gene&l Ho&al of Zakinthos, Greece.
HepatitisC virns(HCV) infectionand interferonalpha(IFN-a) therapy have been associated with autoimmumty. To assess whether chronic liver disease (CLD) due to HCV infection or its treatment with IFN-(r cause autoimmune manifestations, we analysed the prevalence of tissue autoantibodies in 51 children with chronic HCV infection and 84 with other CLD by standard techniques. 65% of patients with chronic HCV infection, 66% with chronic hepatitis B infection and 60% with Wilson’s disease were positive for at least one autoantibody. In the 51 subjects with chronic HCV infection (29 treated with IFN-o, 22 untreated), tested on 165 occasions over a median of 9 months (range: 5-42), autoantibodies to nuclei (ANA), smooth muscle (SMA), gastric parietal cell (GPC) and/or liver kidney microsomal type 1 (LKMl) were similarly prevalent in treated and untreated patients [88 % vs 68 %, P=O. 121. Positivity for SMA was present in 67%. GPC in 32%. ANA in 101, LKMl in 8% of cases. Treatment with IFN-CYhad to be suspended due to transaminase elevation in 1 SMA positive, 1 ANA positive but in three of four LKMl positive patients. Our results show that: (1) autoantibodies are common in viralinduced hepatitis and Wilson’s disease; (2) positivity for SMA, GPC, ANA is associated with chronic HCV infection, their prevalence being unaffected by IFN-(r; (3) IFN-o should be used cautiously in the treatment of LKMl/HCV positive patients.
1 CO6/002
1
GBV-UHGV INFECTION: A FAVOURABLEPRGGNGSTIC FACTOR lN HIV INFECTED PATIENTS?
Immunology, Madizinische Hochschule Hannover, Garmany. To Investigate a possible influcnco of GB vbus-C (GBV-C) In inununocompromised patients, we studied the prevalences of GBV-C RNA (RT-PCR of the S’UTR) and anti-E2 antibody (EIA) in 197 HIV in&ted patients and in 120 control blood donors. With respect to the GBV-C status we difkentiatcd viremic (GBV-C RNA positive), exposed (anti E2 positivc/GBV-C RNA negative) and not exposed HIV patients (anti E2 nagative/GBV-C RNA negative).GBV-C RNA was detected in 331197HIV inkted patients (16.8%) compared to one in 120 blood donors (0.8%) (p~O.001).Previous expomue to GBV-C (anti E2+) was shown in 56,8% of HIV pationts and in 9% of blood ders. Only 52 HIV patients (26,4%) had no markers of GB,V-C infection. Viremia of GBV-C was not associated with hepatitis. Despite of approximately equal duration of HIV infkction in all subgroups, the CD4 co+s were signikantly higher in GBV-C viremic HIV patients (344 cells/~l) compared to exposad (259 cells/~l) and to not exposed patients (170 colls/pl) (p = .017 and p < .OOl). Furthem~re, Kaplan-M&r analysis demonstrated significantly hotter cumulative survival in GBV-C RNA positive HIV patients, suggesting that GBV-C might be a fivourable prognostic factor in HIV disease.
1
Although anti-HCV prevalence in blood donors in Greece is low (0,2-0,40/o), epidemiologic characteristics of HCV infktion in the general population have not been enough shulied.The objective ofthis shrdy was to examine the seropmalenceofHCVi&ctionaadamc&tedriskfactorsinthegeneral popuhtionofZskinthoqaGreckislandinthehiansedwitham&dehed mixed (urban and rural) popohtion. ~:Ahouseboldbealthsurveywascarriedoutinaraodomlyselected sampleof 718 adults (228 urban and 490 roral).A questionnaire was completedandbloodsamplewasobtahedthnallparticipants.Sexum samples were tested for anti-HCV antibodieaby third genuntion ELISA and supplementaltest(Abbot).The hfhxaux of PC characteristics, healthaotewhtsandpossiileassociatcdriskfaaorsontheeeroprevalence of HCV was imw&ted by logistic regrehn analyak. m:The overall anti-HCV prevalence was 1,8%(ud?anpopulation 0,90/r rural 2,25% non sign&ant [email protected] hi&x seroprevahe was hod inmalepopohtion(2.8%vs l.l5%inkmsle)buttheditkewwasnot signiflcant.Tlyewasatrendoficreashgprwalenccwith~,witha signi6~ d&rew(@,oo2) between the age groups 15-44(0%)and over 45 (3, I%).Tbe lo&tic regrehm amdysiscolhmed asi&kantasso&tion behveen anti-HCV positivity and:l)hcrea@ aee(p
pop&ion, indicates that HCV serolnwalence(l.8%) is nmch hi&x than that of blood donors(O,36%in Zakinth).The heasiag prevalence with ageandtheawciationwithpanotarlexposweindicatesthatHCV infectioncanmainlybeattriiedto parenteraltechnicainthepast.
1 CO6/004
1
THYROID TESTS IN PATIENTS WITH HEPATITIS C BEFORE AND DURING lNTERFERON (IFN) a THERAPY -i* E R&&i III Dept. of Internal Medicine, * III Laboratory, Hospital of Brescia, Italy Autoimmune thyroiditis has been reported in patients with chronic hepatitis C, and IFN therapy may be a cause of thyroid dysfunction. We studied 164 patients with chronic hepatitis C (70 M and 94 F, age 51.8k11.5 yrs), 4 with chronic portal hepatitis, 142 with chronic interface hepatitis, and 18 with cirrhosis. IFN a was administered to 108 patients (53 M and 55 F, age 50.7+10.9 yrs) at a dosage of 3 MU 3 times a week (TIW) (n. 44) or 5 MU TIW (n. 64) for 4 months. Responders then received 3 MU TIW for further 8 months. FI3, Fl4, TSH, anti-thyroid peroxidase (TPAb) and anti-thyroglobulin (TGAb) antibodies were determined at baseline and during therapy, every 4 months. Treatment was not considered or suspended in the presence of abnormal thyroid tests. At baseline, subclinical hypothyroidism (increased TSH with normal IT3 and FT4 levels) was detected in 7 F patients, 1 with TPAb, 1 with TGAb and 2 with both. TPAb were found in 4 additional patients (2 M and 2 F) and TGAb in 1 (M). During treatment, subclinical hypothyroidism developed in 4 patients, after 4 (n. 3, 2 M and 1 F) or 8 (n. 1, F) months of treatment. TPAb were detected in 5 patients with normal TSH, after 4 (n. 2, 1 M and 1 F), 8 (n. 2, 1 M and 1 F) or 12 (n. 1, M) months. TGAb were detected in 3 patients with normal thyroid function, after 4 (n. l), 8 (n. 1) or 12 (n. 1) months of treatment. Two of these patients also had TPAb. Abnormal thyroid tests were detected in 7/44 patients starting treatment with 3 MU IFN TIW and in 4/64 patients starting treatment with 5 MU. Clinical hypothyroidism developed in 1 patient treated with 3 MU for 12 months, but thyroid function spontaneously recovered 6 months after IFN discontinuation. Altogether, abnormal thyroid tests were present in 12/164 patients (7.3%, 10 F and 2 M) at baseline and appeared in 111108 patients (10 %, 5 F and 6 M) during treatment. The appearance of thyroid dysfunction and/or autoantibodies during treatment does not seem related to sex or to schedule and duration of treatment.