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Hepatology
Autoantibodies in chronic hepatitis C virus infection: impact on clinical outcomes and extrahepatic manifestations
  1. Andrew J Gilman1,
  2. An K Le2,
  3. Changqing Zhao3,
  4. Joseph Hoang2,
  5. Lee A Yasukawa4,
  6. Susan C Weber4,
  7. John M Vierling5,
  8. Mindie H Nguyen2
  1. 1 Department of Medicine, Stanford University, Palo Alto, California, USA
  2. 2 Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
  3. 3 Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, ShangHai, China
  4. 4 Center for Clinical Informatics, Stanford University, Stanford, California, USA
  5. 5 Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Mindie H Nguyen; mindiehn{at}stanford.edu

Abstract

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.

  • autoimmune liver disease
  • cirrhosis
  • hepatitis C
  • hepatocellular carcinoma

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgast-2018-000203

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    Footnotes

    • Contributors AJG: study design, data collection, data analysis and interpretation, drafting of the manuscript. AKL: study design, data analysis and interpretation, data collection and critical review of the manuscript. CZ, JH, LAY and SCW: data collection, interpretation of data and critical review of the manuscript. JMV: data interpretation and critical review and revision of the manuscript. MHN: concept development, study design, data collection, data analysis and interpretation, drafting of the manuscript, critical revision of the manuscript and supervision of the study; guarantor of article. All authors approved the final version of the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MHN has served as a consultant for Bristol-Myers Squibb, Novartis, Intercept Pharmaceuticals, Anylam Pharmaceutical, Gilead Sciences, Janssen Pharmaceuticals, and Dynavax Laboratories and has received grant/research support from Bristol-Myers Squibb, Gilead Sciences and Janssen Pharmaceuticals. JMV has research grant support from AbbVie, Gilead, Merck, Novartis, Sundise and Taiwan J. He participates in scientific advisory boards for AbbVie, Gilead, Merck, Novartis and Sundise.

    • Patient consent Not required.

    • Ethics approval Institutional Review Board of Stanford University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data available upon request: baseline laboratory analyses, Kaplan-Meier curves for high-titre comparisons and multivariate analyses for high-titre comparisons. Please direct inquiries to MHN via email.