Review for 10.1186/s12876-018-0826-7 (2018)

Reviewer’s report
Title: A Case Series Evaluating the Impact of Hepatitis C Eradication using Direct Acting Antivirals on
Primary Biliary Cholangitis-Associated Autoimmunity.
Version: 1 Date: 24 Jan 2018
Reviewer: Alessandra Mangia
Reviewer's report:
This is an interesting case series focusing on a subgroup of patients with HCV infection and associated
primary biliary cholangitis. This association reported in less than 10% of patients with HCV chronic
infection (Floreani A et al 2003) may be considered an intriguing clinical model.
The Authors describe the ALT/AST levels before and during HCV treatment as well as the fluctuations
in the titres of anti-mitocondrial and anti 3E subunity-BPO.  In two of three patients described here
after an initial decline in autoantibodies titres a following increase during  antiviral treatment was
reported.
Of note,  all  the  patients  considered  in  the  manuscript  achieved  HCV viral  clearance  after  DAA
treatment and regardless of the adopted antiviral regimen. 
The  limitation  of  this  paper  is  the  small  number  of  patients  and  the  differences  in  the  primary
cholangitis treatment (UDCA was used in only one of the three patients). By contrast, the topic is
original and a complete profiling of antibody reactivity is available for every patient.
Main points
My question for the Authors is the following: how they explain the initial decline in antibodies titers?
Was it specific or there are other reports  looking at coexistence of  autoantibodies/autoimmune
diseases  in  HCV  patients?  For  example  in  subjects  positive  for  antithyroid  peroxidase  or  anti
thyroglobulin antibodies?
Can  we  hypothesize  that  with  a  longer  follow  up,  after  HCV  DAA-induced  eradication,  an
improvement of the underlying autoimmune disease can be expected?  Please include all comments for
the authors in this box rather than uploading your report as an attachment. Please only upload as
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Are the methods appropriate and well described?
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Yes
Does the work include the necessary controls?
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Unable to assess
Are the conclusions drawn adequately supported by the data shown?
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Yes
Are you able to assess any statistics in the manuscript or would you recommend an additional 
statistical review?
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assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
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Acceptable
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