Synchronized disappearance of serum HCV-RNA, anti-U1 RNP, anti-La/SS-B, and anti-Scl-70 in a patient with chronic hepatitis

Anti-extractable Nuclear Antigens (ENA) Antibodies in Patients with Chronic Hepatitis C before and after Treatment with Interferon

A high prevalence of serological markers classically associated with autoimmune hepatitis or other autoimmune diseases has been reported in patients with chronic hepatitis C. However, the prevalence of antibodies to extractable nuclear antigens (anti-ENA) are rarely reported in such patients and the effect of treatment with interferon (IFN) on their prevalence is not known. In the present study, serum samples collected from 44 patients with chronic hepatitis C and 44 patients with non-hepatitis C virus (HCV) infected liver diseases were tested for anti-ENAs (U1 RNP, Sm, Ro/SS-A, La/SS-B and Scl-70) antibodies by enzyme-linked immunosorbent assay (ELISA). In 26 patients with chronic hepatitis C who received IFN treatment, serum samples were also collected just after completion of IFN treatment, and/or at 6-40 months after completion of the treatment, and tested for these antibodies. Sixteen (36%) of 44 sera from patients with chronic hepatitis C were positive for at least one of the above anti-ENA antibodies, whereas only 7 (16%) of 44 sera from patients with non-HCV infected liver diseases were positive for such antibodies (p = 0.0290). There was no significant difference in the prevalence of each of anti-ENA antibody between men and women. Results of anti-ENA antibodies in most IFN-treated patients with chronic hepatitis C did not change after treatment. However, in some cases serum anti-U1 RNP, anti-La/SS-B and anti-Scl-70 became negative or converted to the gray zone after completion of IFN treatment regardless of HCV elimination. Our results showed that the overall prevalence of anti-ENA antibodies was significantly higher in patients with chronic hepatitis C than in those with non-HCV-infected liver diseases. However, the disappearance of anti-ENA antibodies after IFN treatment in patients with chronic hepatitis C may be due to the immunomodulating effects of IFN rather than HCV elimination.

Fever of unknown origin secondary to type I crescentic glomerulonephritis and anti-SCl 70 antibodies without clinical manifestations of systemic sclerosis

A 57-year-old woman presented with fever and cellulitis of the right leg. Urinalysis and kidney function were normal on admission. Cellulitis remitted but fever persisted for six weeks. X-ray imaging, cultures, serological assays for viruses and autoimmunity did not reveal the cause of fever. Unexpectedly anti-Scl 70 (anti-topoisomerase I) antibodies were positive. A skin biopsy ruled out scleroderma. On the fifth hospitalization week kidney function declined in association with hematuria, leucocyturia, and proteinuria. Prednisone was administered due to clinical suspicion of drug-induced interstitial nephritis. Fever declined in 24 h, but renal failure became rapidly worse requiring hemodialysis. Kidney biopsy revealed extensive crescentic glomerulonephritis (CGN), with much glomerular destruction, with an IgG-positive linear pattern on immunofluorescence microscopy. No overtly active microangiopathy or vasculitis were present. There was no pulmonary involvement and anti-glomerular basement membrane antibodies were not detected in the serum. After one year anti-Scl 70 antibodies were still positive without scleroderma manifestations and 17 months later the patient received a kidney transplant with excellent results. Presentation of type 1 CGN as a fever of unknown origin (FUO) is exceptional. Anti-Scl 70 antibodies are highly specific for scleroderma and are seldom present in other diseases. As far as we are aware there are no published cases of the association of type 1 CGN with anti-Scl 70 antibodies.

A 5-year prospective study of the late resolution of chronic hepatitis C after antiviral therapy

BACKGROUND

Persistence of hepatitis C virus (HCV) in serum is assured after any course of antiviral therapy that failed to obtain a sustained virological response.

AIM

To evaluate the long-term effect on serum HCV-RNA of a course of pegylated-interferon and ribavirin therapy that was unable to obtain sustained response.

METHODS

Serum HCV-RNA was determined at monthly intervals in 68 non-responders, breakthroughs or relapsers and in 52 naïve controls enrolled in a five-year study.

RESULTS

Five genotype 2 or 3 patients (one non-responder, three breakthroughs, one relapser) cleared HCV-RNA after the end of therapy or relapse, and remained negative until the end of follow-up. HCV-RNA clearance rate in genotype 2 and 3 non-responders, breakthroughs or relapsers was higher than in controls with the same genotypes (22.7% vs. 0%; log-rank 9.62; P < 0.002). HCV-RNA at the end of treatment or at relapse was <10(5) IU/mL in the five subjects who cleared the virus and <10(4) IU/mL in four of them. None of genotype 1 or 4 subjects cleared HCV-RNA during follow-up.

CONCLUSIONS

Late resolution of HCV infection is possible in genotype 2 or 3 patients with low viral load at the end of therapy or at relapse. In these subjects, HCV-RNA monitoring is advisable during the first year after therapy.