Autoimmune hepatitis and hepatitis C infection: diagnostic dieemma

ABSTRACT

The evidence for an association between autoimmune forms of chronic hepatitis and hepatitis C virus [HCV] infection is controversial. Although anti-liver kidney microsomal antibody-positive autoimmune chronic hepatitis appears to be associated with HCV infection, evidence of such an association is less convincing with other subtypes of autoimmune chronic hepatitis. Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers which suggests that HCV elicits an immune response in the host. In a small subset of patient with chronic hepatitis C, autoantibodies are seen in high titers along with hypergammaglobulinemia, which further clouds the distinction between autoimmune chronic hepatitis and chronic hepatitis C.This has important therapeutic implications because inappropriate treatment of autoimmune chronic hepatitis with interferon-based therapy may exacerbate liver disease. Conversely, corticosteroid therapy for chronic hepatitis C may enhance HCV replication, which could worsen underlying liver disease. Few data are available to show how patients with features of both autoimmune hepatitis and chronic hepatitis C should be treated