DETECTION OF HEPATITIS-C VIRUS-ANTIBODY BY 1ST AND 2ND-GENERATION ASSAYS AND POLYMERASE CHAIN-REACTION IN PATIENTS WITH AUTOIMMUNE CHRONIC ACTIVE HEPATITIS TYPE-I, TYPE-II, AND TYPE-III

In this study we have attempted to classify a group of North American patients with autoimmune chronic hepatitis into types I, II, and III a ccording to the class of autoantibody present in serum, and determine the prevalence and significance of antibody to hepatitis C virus (anti -HCV). A total of 62 patients (type I, 51; type II, 3; type III, 8) we re tested with first-generation enzyme-linked immunosorbent assay (ELI SA)-1. Seropositive patients were assessed by second-generation recomb inant immunoblot assay (RIBA)-2 and polymerase chain reaction (PCR). O ur results demonstrate that 12 (19%) of the 62 patients with autoimmun e hepatitis were anti-HCV ELISA-1 positive (type I, 9; type II, I; typ e III, 2). Only one patient with type II autoimmune hepatitis was reac tive by RIBA-2 and PCR. Eight of the 12 seropositive patients entered remission after corticosteroid therapy and seven of them became serone gative by ELISA-1. The RIBA-2 and PCR reactive patient did not respond to immunosuppressive therapy and remained seropositive. We conclude t hat there is a low prevalence of anti-HCV antibody in autoimmune hepat itis. Results based only on ELISA-1 anti-HCV testing can be misleading , and second-generation testing is necessary to recognize the presence of HCV infection. The fact that the only RIBA-2 reactive patient had type II autoimmune hepatitis may suggest a role for HCV infection in t he pathogenesis of this condition. Nevertheless, corticosteroid therap y remains effective in those patients who are ELISA-1 seropositive, bu t RIBA-2 and PCR nonreactive.