Letter to the Editor – Comments on published articles
ANA, lupus and hepatitis C. Comment to “Infection with hepatitis C virus, interferon α and lupus: An odd association”
ANA, lupus y hepatitis C. Comentario a «Infección por virus de la hepatitis C, interferón α y lupus, una curiosa asociación»
María Adoración Martín-Gómez
Unidad de Nefrología, Hospital de Poniente, El Ejido, Almería, Spain
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Comment to “Infection with hepatitis C virus, interferon α and lupus: An odd association”" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "506" "paginaFinal" => "507" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "María Adoración Martín-Gómez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "María Adoración" "apellidos" => "Martín-Gómez" "email" => array:1 [ 0 => "doritamg@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Nefrología, Hospital de Poniente, El Ejido, Almería, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ANA, lupus y hepatitis C. Comentario a «Infección por virus de la hepatitis C, interferón α y lupus, una curiosa asociación»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Regarding the published article by Auñón-Rubio et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> on the development of systemic lupus erythematosus (SLE) in patients with hepatitis C treated with alpha-interferon (IFN-α), I would like to add the issue of some patients with hepatitis C being positive for antinuclear antibodies (ANA), and the possible liver damage of these antibodies.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> I would also like to report the apparently innocuous development of these antibodies after receiving IFN-α,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> which occurred in one of our patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 51-year-old woman with chronic renal failure secondary to interstitial reflux nephropathy, on regular haemodialysis since 1982, testing positive then for genotype 1b HCV. She received a renal transplant in 1988, and re-started haemodialysis due to chronic graft nephropathy in February 2007. In December 2007, after a normal auto-immune study (including ANA), ultrasound, and Fibroscan<span class="elsevierStyleSup">®</span>, she received pegylated IFN monotherapy, with a sustained virologic response and subsequent relapse. In January 2010, she was successfully treated with IFN plus ribavirin, with ribavirin level monitoring. At present, viral load has remained negative, and hepatic Doppler ultrasound and Fibroscan<span class="elsevierStyleSup">®</span> are normal (4.8<span class="elsevierStyleHsp" style=""></span>kPa).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The following complications of antiviral treatment occurred: depressive mood, leukopenia without need for IFN adjustment, graft intolerance syndrome (GIS), and abnormal erythrocyte morphology (dacrocytosis, anisocytosis). These all resolved after finishing treatment, without the need for transplantectomy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding auto-immunity, at baseline, the patient was negative for the various autoantibodies (ANA, ENA, AMA [anti-mitochondrial], ASMA [anti-smooth muscle], APCA [anti-parietal cell] and LKM1 [liver kidney anti-microsomal type 1]), and complement was normal (C3, C4). From the sixth month post-treatment, she began to test positive for ANA, reaching a titre of up to 1:640 on IFL, and then became negative before the first IFN withdrawal. She again tested positive for ANA, after the second IFN treatment, and has remained positive after withdrawal of the drug until present. Anti-DNA and anti-ENA antibodies and complement have always been within the normal range. She has not had any symptoms suggestive of lupus.</p><p id="par0025" class="elsevierStylePara elsevierViewall">“Native” and post-IFN-therapy positivity for ANA autoantibodies are known to occur in patients with hepatitis C,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–6</span></a> being present in up to one third of cases, although the homogeneous pattern is less common.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Other autoantibodies have also been detected in this population (SMA, anti-LKM 1), though less frequently. Therefore, even with a high suspicion of viral liver disease, the protocol is to determine the auto-antibody profile in these patients, due to the co-existence of viral hepatitis and auto-immune hepatitis (AIH), particularly if the patient is to receive antiviral therapy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The ability of ANA antibodies to cause systemic lupus erythematosus has been studied,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> as has their possible relationship to the severity and clinical course of liver disease,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a> though the different ways in which one condition causes the other are not known. Some studies have suggested that in patients with chronic HCV+ hepatitis, the whole panel of auto-antibodies (AMA, ANA, anti-SMA, anti-LKM) could affect the response to interferon and clinical profile of liver disease.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> However, when ANA was analysed separately, it did not appear to confirm these assumptions.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Fortunately, it seems that the presence of these ANAs in HCV+ patients with or without IFN is not related to IFN efficacy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Our patient became positive only for ANA, remaining negative for the rest of the antibodies related to both lupus and AIH. She has not developed either of these clinical syndromes or classical viral relapse (occult HCV not analysed). Although she has not had a liver biopsy at any time, currently, we see no justification for monitoring these antibodies unless she shows clinical or biochemical abnormalities of some form.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In patients with hepatitis C, with or without interferon treatment, ANA not only bears the possibility of developing SLE, but could also be related with the hepatic infection itself.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Gómez MA. ANA, lupus y hepatitis C. Comentario a «Infección por virus de la hepatitis C, interferón α y lupus, una curiosa asociación». Nefrologia. 2015;35:506–507.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por virus de la hepatitis C, interferón-α y lupus, una curiosa asociación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Auñón-Rubio" 1 => "E. Hernández-Martínez" 2 => "A. Sevillano-Prieto" 3 => "E. 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| 2018 August | 84 | 21 | 105 |
| 2018 July | 103 | 16 | 119 |
| 2018 June | 109 | 10 | 119 |
| 2018 May | 87 | 13 | 100 |
| 2018 April | 96 | 10 | 106 |
| 2018 March | 82 | 7 | 89 |
| 2018 February | 100 | 2 | 102 |
| 2018 January | 70 | 6 | 76 |
| 2017 December | 81 | 5 | 86 |
| 2017 November | 66 | 8 | 74 |
| 2017 October | 57 | 7 | 64 |
| 2017 September | 46 | 10 | 56 |
| 2017 August | 46 | 10 | 56 |
| 2017 July | 53 | 7 | 60 |
| 2017 June | 49 | 14 | 63 |
| 2017 May | 59 | 10 | 69 |
| 2017 April | 40 | 13 | 53 |
| 2017 March | 27 | 4 | 31 |
| 2017 February | 42 | 5 | 47 |
| 2017 January | 33 | 7 | 40 |
| 2016 December | 42 | 12 | 54 |
| 2016 November | 56 | 16 | 72 |
| 2016 October | 71 | 13 | 84 |
| 2016 September | 86 | 6 | 92 |
| 2016 August | 111 | 4 | 115 |
| 2016 July | 117 | 7 | 124 |
| 2016 June | 85 | 0 | 85 |
| 2016 May | 117 | 0 | 117 |
| 2016 April | 82 | 0 | 82 |
| 2016 March | 70 | 0 | 70 |
| 2016 February | 89 | 0 | 89 |
| 2016 January | 88 | 0 | 88 |
| 2015 December | 66 | 0 | 66 |
Show all
