The Connection Between Hepatitis C and Autoimmune Disorders

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The Connection Between Hepatitis C and Autoimmune Disordershttp://my.webmd.com/content/article/4/1680_51404.htm?z=1678_00000_0000_f1_09The Connection Between Hepatitis C and Autoimmune Disorders WebMD Medical Reference Archive Infection with the hepatitis C virus (HCV) can lead to autoimmune hepatitis in a minority of patients. This means that the liver cells are damaged not only by the virus but also by the body's own immune system.Autoimmune hepatitis triggers the body to attack its liver cells, as if the liver cells were harmful foreign bodies. Patients with a combination of HCV and autoimmune hepatitis generally suffer from more debilitating symptoms than patients with HCV alone. Autoimmune hepatitis is associated with other autoimmune illnesses, including thyroiditis (inflammation of the thyroid), diabetes mellitus, and ulcerative

colitis (inflammation of the intestines). Although only a few patients with HCV develop autoimmune hepatitis, these patients appear to have a genetic predisposition that makes them more likely to develop autoimmune hepatitis, compared to HCV-infected individuals without that predisposition.Below are some frequently asked questions about the complex relationship between HCV and autoimmune hepatitis.Q. What are the Symptoms of Autoimmune Hepatitis?A. The most common symptom is fatigue. Recurrent jaundice frequently develops in severe cases.Extrahepatic features (those that involve organs and tissue other than the liver) result from the immune system harming] other organs of the body. These symptoms can include amenorrhea (absence of menstrual period), bloody diarrhea (due to ulcerative colitis), abdominal pain, arthritis, rashes, anemia, glomerulonephritis (a form of kidney disease), dry eyes, and dry mouth.Symptoms of autoimmune hepatitis tend

to develop slowly over a period of several weeks or months.Q. What Causes These Symptoms?A. When the immune system becomes activated, as in the case of an autoimmune disease, there is increased production of inflammatory cells (T-cells), antibodies, and other inflammatory mediators (chemicals). The overactivated immune system can lead to systemic symptoms of fatigue and low grade fever. Some of the extrahepatic symptoms, such as glomerulonephritis and arthritis, are due to deposits of antibodies that accumulate in the kidney or joints, leading to damage in those tissues.Q. What is the Process by Which HCV Triggers Autoimmune Conditions?A. Although the mechanism is still poorly understood, it is theorized that proteins appear on the surface of infected liver cells. This leads to an autoimmune response, in which cells of the immune system (including T and B cells) recognize these new proteins as foreign bodies. These cells then attack the liver, causing

inflammation of the liver cells and eventual destruction of liver tissue.Q. How is Autoimmune Hepatitis Diagnosed?A. Autoimmune hepatitis requires laboratory tests to distinguish it from uncomplicated hepatitis C infections. Hypergammaglobulinemia, an excess of antibodies in the blood, is a common finding in autoimmune hepatitis. Blood tests for certain autoantibodies may also provide diagnostic clues. The diagnosis may, however, require a liver biopsy.Q. How is Treatment for Patients with Autoimmunity Determined?A. Interferon is the only approved treatment for HCV, but its use in people with autoimmune hepatitis has been shown to exacerbate symptoms. In general, steroids are used for people with autoimmune hepatitis due to non-viral causes, but in patients with hepatitis C, steroids can increase viral replication.A liver biopsy is usually recommended to determine which disease process is causing the greatest damage to the liver: the HCV

infection or the autoimmune hepatitis. In general, if the HCV infection were predominant and the autoimmune hepatitis mild, alfa interferon treatment would be considered. However, if the autoimmune hepatitis were severe, leading to such complications as kidney damage, rashes, or rapid liver failure, steroids or other immunosuppressant drugs would more likely be recommended.The choice between these treatment options boils down to the immune system. Alfa interferon, which activates the immune system to reduce viral replication, could be problematic for those whose immune system was already over-activated due to severe autoimmune hepatitis. Steroids, which suppress the immune system, could be problematic for those with severe HCV-infection, leading to a compromise the body's ability to fight the infection.Sourceon's Principles of Internal Medicine, Thirteenth Edition, 1994, McGraw-Hill, Inc.[Non-text portions of this message have been

removed]Kathy Brunow