HLA genotyping in type-I autoimmune hepatitis in Western India.

OBJECTIVES: To analyze association of different HLA genotypes for predisposition to type-I autoimmune hepatitis in Western India. METHODS: This study was undertaken on patients of type-I autoimmune hepatitis (defined by international criteria by IAHG, 1999). HLA genotyping for class I and II was done in 20 patients of autoimmune hepatitis and 100 healthy controls. Statistics were done using Halden's modification of Woolfs formula. RESULT: Significant association of autoimmune hepatitis was found amongst class I antigens--HLA B27 [20 vs. 0 %] & HLA cw4 [40 vs. 15 %] and amongst class II antigens--DRBI*01XX [25 vs. 2%], DRB1*14XX [30 vs. 12%], DRB1*15XX [40 vs. 25%] and DRB1*07XX [20 vs. 9 %] at DRB1 locus. Stronger association was found with HLA B27, cw4 & HLA DRB1 *01XX. CONCLUSION: Our data indicate that predisposition to autoimmune hepatitis is different in Indian patients and not associated with HLA DRB1*03XX or *04XX, as seen in Western world.

HLA class II genotyping in chronic hepatitis B infection.

OBJECTIVES: To analyze the role of HLA genotypes in persistence of chronic hepatitis B in Western India. METHODS: HLA genotyping for class II-DR was done in 26 subjects having chronic hepatitis B infection (HBsAg positive) and in 100 healthy controls. Statistics were done using Halden's modification of Woolf's formula. RESULT: Significant association of chronic hepatitis B infection was found for class II-DR antigens DRB1*15XX (57.6 vs. 25%) and DRB1*11XX (23 vs. 4%). DRB1*13XX (0 vs. 19%) was negatively associated with chronic hepatitis B infection. CONCLUSION: HLA phenotype, which varies with different regions, is one of the factors in persistence of hepatitis B infection. Our study supports negative association of DRB1*13XX to persistence of HBV. Also there may be role of DRB1*11XX and DRB1*15XX in persistence of HBV and development of chronic HBV hepatitis.

Prevalence of hepatitis C genotypes in Indian patients and their clinical significance.

AIM: To study the significance of hepatitis C genotypes in relation to severity of liver disease, progression of liver disease and response to treatment. METHODS: Sixty one consecutive patients with hepatitis C infection were evaluated with detailed history, clinical examination, biochemical, imaging and virological profile, liver histology whenever feasible. Hepatitis C infection was confirmed with AntiHCV third generation ELISA assay. HCVRNA by PCR and HCV genotyping by direct sequencing. RESULTS: Demographic profile of patients was as M:F 36:25, mean age 46.3 +/- 13.6 years (range 10 to 70 years). Clinical presentations of these patients were as cirrhosis 23, cirrhosis with HCC 3, chronic hepatitis 22, acute hepatitis 4, asymptomatic with normal enzymes nine. Distribution of genotypes was as follows; 13/61 (21%) genotype I, 15/61 (25%) genotypes II and 33/61 (54%) genotype III. Cirrhosis was significantly common in genotype I (77%) when compared to genotype II and III (33%); p < 0.001. Mean time of presenting as cirrhosis was much faster in genotype I (8.7 +/- 6.7 years) as compared to other genotypes (type II 12.8 +/- 4.2 years and genotype III 15.8 +/- 6.9 years). Genotype distribution in CRF and renal transplant patient was genotype I 8/23 (35%), genotype II 5/23 (22%) and genotype III 10/23 (43%). Fourteen patients were treated with interferon and ribavarine combination for one year. Sustained response seen in 8/14 (57%). All these patients had genotype non 1. All the four patients with Genotype I were non-responders. CONCLUSION: Hepatitis C genotype III is common in India, Genotype I runs a more severe course, faster progression and non responders to interferon as compared with genotype II and III.

Association of HLA B27 antigen in Indian patients of ankylosing spondylitis and other autoimmune diseases.

One thousand three hundred and forty clinically suspected patients of Ankylosing Spondylitis (AS) and other autoimmune diseases and 5000 controls were studied to detect the association of HLA B27 antigen amongst them. Other alleles studied include HLA B7, B40 (B60), B22(B55), B13, etc. Our findings show a considerable and consistent association of HLA B27 with AS irrespective of the community to which the patient, belonged his hygiene or socio-economic conditions. We also found that people in the age group of 21-39 were the most vulnerable, when number of affected individuals or severity of the disease were taken into consideration. Male members showed a preponderance over females in HLA B27 positivity. Detection of HLA B27 could help in the diagnosis of AS. Patients suffering from other autoimmune diseases such as rheumatoid arthritis, psoriasis, Reiter's syndrome and uveitis and patients with inflammatory bowel disease, colitis, eczema, bacillary or fungal infection were also found to be HLA B27 positive. A study of other alleles shows that even they sometimes associate AS and other autoimmune diseases.