Results of steroid-based therapy for the hepatitis C-autoimmune hepatitis overlap syndrome

OBJECTIVE: Overlap syndromes in which persons manifest clinical, histologic al, or immunological features of both hepatitis C infection and autoimmune hepatitis are well described. The discordant forms of treatment for hepatit is C and autoimmune hepatitis have made medical management of these patient s difficult. We report our experience in using corticosteroids as first lin e therapy for the hepatitis C-autoimmune hepatitis overlap syndrome. METHODS: Seven patients with this overlap syndrome (diagnosis based on the presence of serum hepatitis C antibody by RIBA and serum hepatitis C RNA by polymerase chain reaction. and serum hypergammaglobulinemia, elevated ANA or ASMA titers, or histological findings consistent with autoimmune hepatit is) were treated with prednisone with or without azathioprine or cyclospori ne, and followed for a median duration of 44.5 months. RESULTS: Five patients (71%) showed improvement of median serum ALT level f rom 162 U/L to 38 U/L (p = 0.04) and median serum gamma -globulin from 2.1 g/dl to 1.4 g/dl (p = 0.04) by 6 months of therapy. The mean modified histo logical activity index score also decreased from 11.4 +/- 2.5 to 6.6 +/- 2. 6 (p = 0.04) by at least 1 yr of therapy. One patient discontinued predniso ne while taking azathioprine and experienced a rebound elevation of serum A LT that did not respond to retreatment with prednisone. Antiviral therapy w as subsequently administered and resulted in biochemical and virologic resp onse. Hepatitis C virus RNA remained detectable in all other patients. CONCLUSION: Corticosteroids are beneficial as a first line therapy for some patients with the hepatitis C-autoimmune overlap syndrome, resulting in ap preciable biochemical and histological response but without viral eradicati on. (Am J Gastroenterol 2001;96:2984-2991. (C) 2001 by Am. Coll. of Gastroe nterology).