HEPATITIS-C VIRUS-RELATED AUTOIMMUNITY IN PATIENTS WITH PORPHYRIA-CUTANEA-TARDA

Hepatitis C virus (HCV) infection is frequently found in autoimmune he patitis and mixed cryoglobulinaemia. In these conditions HCV could be responsible for immune-mediated organ alterations. The aim of this stu dy was to evaluate the presence of immunological alterations in PCT pa tients, in which HCV infection has been frequently found. Twenty-three PCT patients were evaluated for clinical and serological alterations, including: chronic hepatitis, other systemic symptoms, serum cryoglob ulins and rheumatoid factor (RF), haemolytic complement, serum immunog lobulins, anti-nuclear (ANA), antismooth muscle (ASMA), anti-liver-kid ney-microsomal (anti-LKM1); anti-soluble-liver-antigen (SLA), anti-mit ochondrial (AMA), anti-GOR antibodies, anti-HCV and HCV RNA. Abnormal serum ALT were present in the majority of cases (20/23, 87%), while li ver biopsy revealed a chronic persistent hepatitis or chronic active h epatitis in 15/20 (75%) PCT patients. In a high percentage of subjects (91%) the presence of anti-HCV was detected by ELISA and RIBA II (Chi ron, Emeryville CA, USA). In 17/22 (77%) cases the ongoing HCV replica tion in the serum was demonstrated by the detection of HCV genomes (po lymerase chain reaction). The prevalence of both anti-HCV and HCV RNA in PCT was significantly higher if compared to 22 systemic immunologic al diseases (P < 0.001) and 47 healthy subjects (P < 0.001). A possibl e HCV-induced autoimmunity in PCT was suggested by the presence of the following immunological parameter alterations: anti-GOR in 13/23 (57% ), ANA in 4/23 (17%), ASMA in 18/23 (78%), anti-LKM1 in 1/23 (4%), RF in 23/23 (100%), mixed cryoglobulins in 4/23 (17%), complement consump tion in 10/23 (43%). The high prevalence of HCV infection and various immunological abnormalities suggest that HCV in combination with other factors (genetic, alcohol, etc.) could play a relevant role in the pa thogenesis of hepatic and metabolic alterations of PCT.