INTERFERON AND PREDNISONE THERAPY IN CHRONIC HEPATITIS-C WITH NON-ORGAN-SPECIFIC ANTIBODIES

Background/Aims: The relationship between hepatitis C virus and autoim munity is controversial. The issue is particularly relevant in those p atients with hepatitis C virus infection and serum autoantibodies in w hom steroids can exacerbate viral replication and interferon can lead to decompensated liver disease. The aim of this study was to evaluate the response to a course of prednisone or interferon-alpha 2b. Methods /Results: The 12 study patients had biopsy-proven chronic hepatitis, s erum HCV-RNA (by nested polymerase chain reaction) and non-organ-speci fic antibodies (eight with liver and kidney microsomal antibodies and four with antinuclear antibodies). Eight of these 12 patients received a 4-month course of prednisone (0.5 mg/kg per day), which increased a lanine aminotransferase (mean+/-SE) (174+/-31 vs 252+/-18 U/l, p<0.05) and bilirubin levels (0.96+/-0.17 vs 1.42+0.18 mg/dl, p=0.09), withou t changing liver histology (Knodell index, 13.6+/-0.4 vs 13.1+/-0.3). Subsequent treatment with interferon in the 12 patients reduced serum alanine aminotransferase levels (170+/-20 vs 41+/-7 U/l, p<0.0001) and portal and lobular inflammation (Knodell index, 13.8+/-0.5 vs 8.4+/-0 .2, p<0.001). A complete response to interferon was observed in ten of these patients (83%), eight of whom had previously been treated with prednisone. Serum HCV-RNA level decreased in interferon responders. A sustained response 1 year after withdrawal of interferon was seen in o nly five patients (41%). Conclusions: Patients with chronic hepatitis C and autoantibodies show a favorable response to interferon, but not to prednisone. The latter regimen can exacerbate liver necrosis in the se subjects. The presence of autoantibodies in hepatitis C patients do es not modify the response to interferon.