Chronic Hepatitis with Combined Features of Autoimmune Chronic Hepatitis and Chronic Hepatitis C: Favorable Response to Prednisone and Azathioprine
Authors: Somashekhar Bellary, Thomas Schiano, Grace Hartman, Martin Black
Journal: Annals of Internal Medicine (1995)

Brief Communications1 July 1995Chronic Hepatitis with Combined Features of Autoimmune Chronic Hepatitis and Chronic Hepatitis C: Favorable Response to Prednisone and AzathioprineSomashekhar Bellary, MD, Thomas Schiano, MD, Grace Hartman, MD, and Martin Black, MDSomashekhar Bellary, MDFrom Temple University Hospital, Philadelphia, Pennsylvania.Search for more papers by this author, Thomas Schiano, MDFrom Temple University Hospital, Philadelphia, Pennsylvania.Search for more papers by this author, Grace Hartman, MDFrom Temple University Hospital, Philadelphia, Pennsylvania.Search for more papers by this author, and Martin Black, MDFrom Temple University Hospital, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-1-199507010-00004 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The evidence for an association between autoimmune forms of chronic hepatitis and hepatitis C virus (HCV) infection is controversial [1-3]. Although anti-liver-kidney microsomal antibody-positive autoimmune chronic hepatitis appears to be associated with HCV infection [4], evidence of such an association is less convincing with other subtypes of autoimmune chronic hepatitis [5]. Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers [6-8], which suggests that HCV elicits an immune response in the host. In a small subset of patients with chronic hepatitis C, autoantibodies are seen in high titers along with hypergammaglobulinemia, which further clouds ...References1. Nishioka M. Nuclear antigens in autoimmune hepatitis. In: Meyer Zum Burchenfelde KH, Hoofnagle JH, Manns MP, eds. Immunology and the Liver. Dordrecht: Kluwer; 1993:193-204. Google Scholar2. Mitchel LS, Jeffers LJ, Reddy KR, Cheinquer H, Coelho-Little E, Moreda R, et al. Detection of hepatitis C virus antibody by first and second generation assays and polymerase chain reaction in patients with autoimmune chronic active hepatitis types I, II, and III. Am J Gastroenterol. 1993; 88:1027-34. Google Scholar3. Michel G, Ritter A, Gerken G, Meyer zum Buschenfelde KH, Decker R, Manns MP. Anti-GOR and hepatitis C virus in autoimmune liver diseases. Lancet. 1992; 339:267-9. Google Scholar4. Lunel F, Abuaf N, Frangeul L, Grippon P, Perrin M, Le Coz Y, et al. Liver/kidney microsome antibody type 1 and hepatitis C virus infection. Hepatology. 1992; 16:630-6. Google Scholar5. Lenzi M, Johnson PJ, McFarlane IG, Ballardini G, Smith HM, McFarlane BM, et al. Antibodies to hepatitis C virus in autoimmune liver disease: evidence for geographical heterogeneity. Lancet. 1991; 338:277-80. Google Scholar6. Donahue D, Smith L, Luttig B, Manns M, Bonkowsky H. High prevalence of markers of autoimmunity in patients with chronic hepatitis C (Abstract). Hepatology. 1993; 18:84A. Google Scholar7. Merican I, Sherlock S, McIntyre N, Dusheiko GM. Clinical biochemical and histological features in 102 patients with chronic hepatitis C virus infection. Q J Med. 1993; 86:119-25. Google Scholar8. Fried MW, Draguesku JO, Shindo M, Simpson LH, Banks SM, Hoofnagle JH, et al. Clinical and serological differentiation of autoimmune and hepatitis C virus-related chronic hepatitis. Dig Dis Sci. 1993; 38:631-6. Google Scholar9. Papo T, Marcellin P, Bernuau J, Durand F, Poynard T, Benhamou JP. Autoimmune chronic hepatitis exacerbated by α-interferon. Ann Intern Med. 1992; 116:51-3. Google Scholar10. Black M, Peters M. Alpha-interferon treatment of chronic hepatitis C: need for accurate diagnosis in selecting patients (Editorial). Ann Intern Med. 1992; 116:86-8. Google Scholar11. Fong TL, Valinluck B, Govindarajan S, Charboneau F, Adkins RH, Redeker AG. Short-term prednisone therapy affects aminotransferase activity and hepatitis C virus RNA levels in chronic hepatitis C. Gastroenterology. 1994; 107:196-9. Google Scholar12. Magrin S, Craxi A, Fabriano C, Simonetti RG, Fiorentino G, Marino L, et al. Hepatitis C viremia in chronic liver disease: relationship to interferon-alfa or corticosteroid treatment. Hepatology. 1994; 19:273-9. Google Scholar13. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, et al. Formulation and application of a numerical scoring system for assessing histologic activity in asymptomatic chronic active hepatitis. Hepatology. 1981; 1:431-5. Google Scholar14. Ulrich PP, Romeo JM, Lane PK, Kelly I, Daniel LJ, Vyas GN. Detection, semiquantitation, and genetic variation in hepatitis C virus sequences amplified from the plasma of blood donors with elevated alanine aminotransferase. J Clin Invest. 1990; 86:1609-14. Google Scholar15. Nishiguchi S, Kuroki T, Ueda T, Fukuda K, Takeda T, Nakajima S, et al. Detection of hepatitis C virus antibody in the absence of viral RNA in patients with autoimmune hepatitis. Ann Intern Med. 1992; 116:21-5. Google Scholar16. Magrin S, Craxi A, Fabiano C, Fiorentino G, Almasio P, Palazzo U, et al. Hepatitis C viral replication in ‘autoimmune’ chronic hepatitis.J Hepatol. 1991; 13:364-7. Google Scholar17. Shindo M, DiBisceglie AM, Hoofnagle JH. Acute exacerbation of liver disease during interferon alfa therapy for chronic hepatitis C. Gastroenterology. 1992; 102:1406-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Temple University Hospital, Philadelphia, Pennsylvania.Corresponding Author: Martin Black, MD, Liver Unit, Department of Gastroenterology, 8th Floor, Parkinson Pavilion, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140.Acknowledgment: The authors thank Lynne Rivers for secretarial assistance.Grant Support: By a grant from Shering-Plough Corporation. 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