RELATION BETWEEN AUTOIMMUNE LIVER-DISEASES AND VIRAL-HEPATITIS - CLINICAL AND SEROLOGICAL CHARACTERISTICS IN 859 PATIENTS

An etiopathological link between hepatitis virus infection and autoimm une liver disease, in particular autoimmune hepatitis has been suggest ed. In some patients features of both viral and autoimmune disease are present. We have studied 352 patients with autoimmune liver disease a nd 507 patients with viral hepa titis for diagnostic characteristics a s well as for evidence of an etiological connection. 38 of the 201 pat ients with hepatitis C (19%) and 42 of the 306 patients with hepatitis B (14%) had significant titres of autoantibodies (ANA, SMA or LKM). S LA autoantibodies were found exclusively in patients with autoimmune l iver disease. LKM autoantibody was found in only one of the 201 HCV pa tients. Evidence of past or present hepatitis B virus and past hepatit is A virus infection was most common in the hepatitis C virus patients and least common in autoimmune hepatitis. 28 of the 352 patients with autoimmune liver diseases tested positive in the second generation an ti-HCV ELISA, but only five patients (two with autoimmune hepatitis, o ne with primary sclerosing cholangitis and two with primary biliary ci rrhosis) were positive in confirmatory anti-HCV assays, and only in th ese could HCV-RNA be isolated. Autoimmune hepatitis patients had signi ficantly higher transaminase, GLDH and IgG levels. HLA-B8, HLA-DR3 and HLA-DR4 were significantly more common in autoimmune hepatitis. Disti nction between autoimmune liver disease and viral hepatitis C could be made reliably on clinical and laboratory grounds. Our data show that a link between hepatitis A, B, or C virus infection and autoimmune liv er diseases is highly unlikely. Although false positive anti-HCV ELISA results can be found in about 5% of patients with autoimmune liver di seases, true HCV-infection in particular is a rare event.