AUTOIMMUNE HEPATITIS AND OR HEPATITIS-C - HOW TO DECIDE/

The evidence for an association between autoimmune forms of chronic he patitis and hepatitis C virus (HCV) infection is controversial, Althou gh anti-liver-kidney microsomal antibody-positive autoimmune chronic h epatitis appears to be associated with HCV infection, evidence of such an association is less convincing with other subtypes of autoimmune c hronic hepatitis, Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers, which suggests t hat HCV elicits an immune response in the host, In a small subset of p atients with chronic hepatitis C, autoantibodies are seen in high tite rs along with hypergammaglobulinemia, which further clouds the distinc tion between autoimmune chronic hepatitis and chronic hepatitis C. Thi s has important therapeutic implications because inappropriate treatme nt of autoimmune chronic hepatitis with interferon-alpha may exacerbat e liver disease. Conversely, corticosteroid therapy for chronic hepati tis 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, We describe two patients with combined features of autoimmune chronic hepatitis and chronic hepatitis C who showed clinical, biochemical, an d histologic responses to treatment with prednisone and azathioprine.