Autoimmune diseases and chronic viral hepatits

ABSTRACT

Autoimmune diseases may be associated with chronic viral hepatitis though the nature of the association is not clearly understood. Immune mediated response against viral antigens expressed on the hepatocytes may explain the liver damage in chronic viral infection. Associated diseases with chronic viral hepatitis such as glomerulonephritis, vasculitis and rheumatoid arthritis could be induced by immunological mechanisms including viral antigen-antibody production and circulating immune complex deposition. However, other diseases [autoimmune thyroiditis, TCP and Sjogren's syndrome] may be autoantigen mediated. The present study reviews the pathogenesis of autoimmunity, pathogenesis of chronic viral hepatitis and the role of molecular mimicry so as to try to answer the questions; Can hepatotropic viruses induce autoimmune diseases association of autoimmune hepatitis and chronic viral hepatitis coincidental or facilitative light on the treatment of combined autoimmune diseases and chronic viral hepatitis. A review of different studies suggests that 1. Autoimmune diseases may be associated with chronic viral hepatitis [HBV and HCV]. 2. These viruses may skew the immune system to produce autoantibodies. 3. Hepatotropic viruses may be a causative [but not major] factor for autimmune disease. 4. Immunoregulatory abnormalities may be involved in the pathogenesis of autoimmune-associated chronic viral hepatitis and genetic factors may be involved 5. Different therapeutic modalities are used. The following guide may be followed. If viral infection is predominating High viral load [HCV], HBeAg + ve and DNA +ve [HBV], Interferon may be given. Thyroid function, thyroid autoantibodies and platelets should be observed. If autoimmune features are predominating; high autoantibodies titer> 1320, positive thyroid autoantibodies, thyroid dysfunction and thrombocytopenia; immunosuppression may be justified. Low dose of steroids or cyclosporin-A or a combination of lower doses or Tacrolimus and Mycophenolate Mofetil. Viral activation should be observed. If both viral infection and autoimmune features are predominating; a short course of immunosuppression [2 weeks] is given followed by Interferon