AUTOANTIBODY PREVALENCE IN CHILDREN WITH LIVER-DISEASE DUE TO CHRONICHEPATITIS-C VIRUS (HCV) INFECTION

HCV infection and interferon-alpha (IFN-alpha) therapy have been assoc iated with autoimmunity. To assess whether chronic liver disease (CLD) due to HCV infection or its treatment with IFN-alpha cause autoimmune manifestations, the prevalence of tissue autoantibodies in 51 childre n with chronic HCV infection and 84 with other CLD was analysed by sta ndard techniques. Sixty-five percent of patients with chronic HCV infe ction, 66% with chronic hepatitis B infection and 60% with Wilson's di sease were positive for at least one autoantibody. In the 51 subjects with chronic HCV infection (29 treated with IFN-alpha, 22 untreated), tested on 165 occasions over a median of 9 months (range 5-42 months), autoantibodies to nuclei (ANA), smooth muscle (SMA), gastric parietal cell (GPC) and/or liver kidney microsomal type 1 (LKM-1) were similar ly prevalent in treated and untreated patients (90% versus 68%, P= 0.1 2). Positivity for SMA was present in 67%, GPC in 32%, ANA in 10%, LKM -1 in 8% of cases. Treatment with IFN-alpha had to be suspended due to transaminase elevation in one SMA-positive, one ANA-positive but in t hree of four LKM-1-positive patients. Our results show that: (i) autoa ntibodies are common in viral-induced hepatitis and Wilson's disease; (ii) positivity for SMA, GPC, ANA is part of the natural course of chr onic HCV infection, their prevalence being unaffected by IFN-alpha; an d (iii)IFN-alpha should be used cautiously in the treatment of LKM-1/H CV-positive patients.