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2018 ; 5
(1
): e000203
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Autoantibodies in chronic hepatitis C virus infection: impact on clinical
outcomes and extrahepatic manifestations
#MMPMID29755758
Gilman AJ
; Le AK
; Zhao C
; Hoang J
; Yasukawa LA
; Weber SC
; Vierling JM
; Nguyen MH
BMJ Open Gastroenterol
2018[]; 5
(1
): e000203
PMID29755758
show ga
GOALS: To examine the role that autoantibodies (auto-abs) play in chronic
hepatitis C virus (HCV) regarding demographics, presence of extrahepatic
manifestations and long-term outcomes in a large US cohort. BACKGROUND: Auto-abs
have been reported to be prevalent in patients with chronic HCV infection, but
data on the natural history of these patients are limited. STUDY: The study
included 1556 consecutive patients with HCV without concurrent HIV and/or HBV who
had testing for antinuclear antibody (ANA), antimitochondrial antibody (AMA),
antismooth muscle antibody (ASMA) and/or antiliver kidney microsomal antibody
(LKM). Primary outcomes included development of cirrhosis, hepatic
decompensations, hepatocellular carcinoma (HCC), mortality and/or sustained
virological response (SVR) to antiviral therapy. RESULTS: A total of 388 patients
tested positive for any auto-ab (ANA 21.8%, ASMA 13.3%, AMA 2.2% and LKM 1.2%).
Patients who tested positive versus negative were more likely to be women (29.3%
vs 20.9%, p<0.001) and less likely to achieve SVR with most treated patients
receiving interferon-based therapies (37.2% vs 47.1%, p=0.031). There was no
difference between groups for baseline laboratory data, disease state or rate of
extrahepatic manifestations (42.8% vs 45.0%, p=0.44). Kaplan-Meier analysis
revealed no statistically significant difference between groups for the 10-year
development of cirrhosis, hepatic decompensations, HCC nor survival. Furthermore,
auto-ab positivity was only found to be a predictor for a lower rate of SVR on
multivariate analysis (adjusted OR=1.61, 95 % ?CI 1.00 to 2.58, p=0.048).
CONCLUSIONS: In our cohort, auto-ab positivity was common, especially in women,
and predicted a lower rate of SVR but otherwise had no impact on the natural
history of chronic HCV or presence of extrahepatic manifestations.