INSULIN-DEPENDENT DIABETES-MELLITUS DURING ALPHA-INTERFERON THERAPY FOR CHRONIC VIRAL-HEPATITIS

A 29-year-old man was observed to develop insulin-dependent diabetes m ellitus following a 5-month treatment with recombinant alpha-2b-interf eron for chronic hepatitis C. After the onset of the disease, serum sa mples that had, respectively, been collected before therapy commenceme nt, at month 3, and at the onset of insulin-dependent diabetes mellitu s were tested for islet-cell (ICA-IgG), glutamic acid decarboxylase (G AD-Abs), IA2 (IA2-Abs) and insulin (IA-Abs) autoantibodies. The follow ing results were obtained: ICA-IgG, 5, >80, and >80 JDF-U, respectivel y; GAD-Abs: >100 U/ml in all three measurements; IA2-Abs and IA-Abs: n egative. During treatment, thyroid microsomal autoantibodies increased markedly (from 1:100 to 25 600 titer); thyroid-stimulating hormone wa s persistently normal. HLA class II typing revealed a genetic predispo sition to insulin-dependent diabetes mellitus as demonstrated by the p resence of DRB1 04/08, DQ Al 52 Arg+/Arg+, and DQB1 57 N-Asp/Asp alle les. One year after the onset of insulin-dependent diabetes mellitus, the patient is still receiving 30 IU insulin daily; the liver function tests are normal and HCV-RNA is negative. These data support the hypo thesis that, in predisposed patients, alpha-interferon therapy can enh ance an ongoing autoimmune process against pancreatic beta-cells and i nduce overt insulin-dependent diabetes mellitus. We therefore suggest that, in patients with a documented predisposition to insulin-dependen t diabetes mellitus, alpha-IFN therapy should be administered with cau tion.