G. Provenzano et al., INTERFERON AND STEROID TREATMENT IN PATIENTS WITH CHRONIC HEPATITIS-CAND ANTINUCLEAR OR ANTI-LIVER-KIDNEY MICROSOMAL ANTIBODIES, The Italian Journal of Gastroenterology, 28(7), 1996, pp. 377-380
Treatment of HCV-related chronic hepatitis is controversial when non-o
rgan specific autoantibodies are present, due to potential severe auto
immune reactions under interferon, We evaluated, in an open study, a s
equential approach (steroid -> interferon) in 20 consecutive patients,
vith biopsy-proven chronic hepatitis, anti-HCV positive (EIA2/RIBA2) a
nd autoantibody positive at a titre greater than or equal to 1/80 (18
antinuclear and 2 anti-liver-kidney microsomal antibodies), Nine patie
nts responded to steroids (ALT reduced by greater than or equal to 50%
at 12 weeks) and continued on prednisone up to one year, Notably, ALT
did not return to normal and steroid treatment was ineffective in con
trolling necroinflammation on follow-up biopsies, After stopping predn
isone, ALT rebounded to pre-treatment levels in 6/9 cases, Four of the
se 6 then received interferon: 3 of them had a complete response (e.g.
normal ALT at end of therapy), in 2 with loss of HCV RNA, Eleven pati
ents were, instead, steroid resistant and after wash-out were switched
to lymphoblastoid alfa-interferon (6 MU t.i.w. for 8 weeks, 3 MU t.i.
w. for 16 weeks), Four cases had a complete response to interferon (3
with loss of HCV RNA) with follow-up biopsies showing definite reducti
on of necroinflammation, None of the 15 receiving interferon in the pr
esent study experienced ALT peaks, deterioration of liver disease, aut
oimmune-like phenomena, We suggest that antiviral treatment with alfa-
interferon could be the first choice in chronic hepatitis C, even in a
utoantibody positive cases.