1Mabrouk
Ghonaim, 2Abdullah Al-Ghamdi, 1Hassan El-Bana, 1Ahmed
Bakr, 3Enas Ghoneim, 4Rawhia El-Edel, 5Mona
Hassona, 6Sabry Shoeib and 7Heba Allam
Departments of 1,2,3,7Microbiology and
Immunology, 4,5Clinical Pathology, and 6Internal
Medicine, 1,3,5Faculty of Medicine and 3,5,7Liver
Institute, Menoufiya University, Menoufiya
Some hepatotropic viruses (HBV and HCV) are capable of
triggering autoimmune phenomena and manifest the features of autoimmune
hepatitis (AIH) in the course of the disease. Careful attention is required to
differentiate between AIH and chronic viral hepatitis (CVH) before the
selection of treatment. This study was performed to assess the prevalence of
rheumatoid factor (RF), antinuclear antibodies (ANA), anti-smooth muscle
antibodies (ASMA), anti-mitochondrial antibodies (AMA), anti-parietal cell
antibodies (APCA), anti-liver/ kidney microsomal antibodies type I (ALKMA1) and
anti-neutrophil cytoplasmic antibodies (ANCA) among patients with chronic liver
diseases (CLD), and to assess the diagnostic value of these autoantibodies and
their relation to HCV viral load and genotype and treatment with
interferon-alpha (IFN-α). Five groups of patients with CLD (HCV, HBV, HCC,
AIH and schistosomal hepatic fibrosis {SHF}) as well as a group of age- and
gender-matched healthy controls were enrolled in the study. All the studied
persons were subjected to full clinical assessment and laboratory
investigations, including liver function tests, hepatitis markers, and HCV RNA
by PCR. Detection of ANA, ASMA, APCA, AMA and ALKMA-1 was done by indirect
immunofluorescence technique, while ANCA and RF were detected by EIA and latex
agglutination test respectively. Results showed a significantly higher
prevalence of RF, ASMA and ANCA among patients with CHC, RF and ASMA among HCC
patients and ASMA and ALKMA1, among AIH patients as compared to the control
group. Patients with HBV and those with SHF had a non-significantly higher
prevalence of RF, ASMA and ANCA compared to controls. However, AMA was not
detected in this study, and APCA showed no significant difference between the
studied groups. The occurrence of these autoantibodies was not significantly
related to HCV viral load, HCV genotype or treatment with IFN-α. There was
a significant association between the occurrence of RF, ANA, ASMA, and ALKMA1
and high ALT levels, and between the occurrence of ANA, ASMA and ALKMA-1 and
high AST and ALP levels. In conclusion, autoantibodies are commonly found among
patients with HCV infection. The co-existence of HCV infection and autoimmune
hepatitis should be considered in patients who are positive for both viral
markers and autoantibodies and thorough evaluation of patients must be
performed before selection of treatment. Testing for RF, ASMA and ANCA may have
a good diagnostic value, however, AMA is the least useful in diagnosis.