Abstract
Chronic hepatitis C virus (HCV) infection predisposes patients to the onset of diseases involving other organ systems. Indeed, more than 50% of patients with HCV infection develop at least one autoimmune extrahepatic manifestation. These manifestations may be triggered by virus-induced autoimmunity with autoantibody production, autoreactive T cells, and intricate autoimmune reactions that lead to organ-specific or non-organ-specific autoimmune diseases involving the kidneys, skin, eyes, joints, nervous system, etc. Some extrahepatic manifestations of hepatitis C are relatively common (e.g., cryoglobulinemia), while others, such as autoimmune thyroid diseases or type 1 diabetes mellitus, are uncommon and their association with HCV has yet to be fully elucidated. In this chapter, we consider the main organ-specific autoimmune disorders directly related to HCV infection or indirectly induced by treatment for HCV infection, and interferons in particular.
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References
Lauer GM, Walker BD (2001) Hepatitis C virus infection. N Engl J Med 345:41–52
Cacoub P, Renou C, Rosenthal E et al (2000) Extrahepatic manifestations associated with hepatitis C virus infection. A prospective multicenter study of 321 patients. Groupe d’Etude et de Recherche en Médecine Interne et Maladies Infectieuses sur le Virus de l’Hepatite C. Medicine (Baltimore) 79:47–56
Zignego AL, Piluso A, Giannini C (2008) HBV and HCV chronic infection: autoimmune manifestations and lymphoproliferation. Autoimmun Rev 8:107–111
Ferri S, Muratori L, Quarneti C et al (2008) HCV and autoimmunity. Curr Pharm Des 14:1678–1685
Sene D, Ghillani-Dalbin P, Thibault V et al (2006) Longterm course of mixed cryoglobulinemia in patients infected with hepatitis C virus. J Rheumatol 31:2199–2206
Saadoun D, Landau DA, Calabrese LH, Cacoub PP (2007) Hepatitis C-associated mixed cryoglobulinaemia: a Âcrossroad between autoimmunity and lymphoproliferation. ÂRheuÂmatology (Oxford) 46:1234–1242
Betterle C, Fabris P, Zanchetta R et al (2000) Autoimmunity against pancreatic islets and other tissue before and after interferon-α therapy in patients with hepatitis C virus chronic infection. Diabetes Care 23:1177–1181
Bini EJ, Mehandru S (2004) Incidence of thyroid dysfunction during interferon alpha-2b and ribavirin therapy in men with chronic hepatitis C: a prospective cohort study. Arch Intern Med 164:2371–2376
Antonelli A, Ferri C, Pampana A et al (2004) Thyroid disorders in chronic hepatitis C. Am J Med 117:10–13
Baccala R, Kono DH, Theofilopoulos AN (2005) Interferons as pathogenic effectors in autoimmunity. Immunol Rev 204:9–26
Gregorio GV, Choudhuri K, Ma Y et al (2003) Mimicry between the hepatitis C virus polyprotein and antigenic targets of nuclear and smooth muscle antibodies in chronic hepatitis C virus infection. Clin Exp Immunol 133:404–413
Pileri P, Uematsu Y, Campagnoli S et al (1998) Binding of hepatitis C virus to CD81. Science 282:938–941
Deng J, Dekruyff RH, Freeman GJ et al (2002) Critical role of CD81 in cognate T-B cell interactions leading to Th2 responses. Int Immunol 14:513–523
Akeno N, Blackard JT, Tomer Y (2008) HCV E2 protein binds directly to thyroid cells and induces IL-8 production: a new mechanism for HCV induced thyroid autoimmunity. J Autoimmun 31:339–344
Dayan CM, Daniels GH (1996) Chronic autoimmune Âthyroiditis. N Engl J Med 335:99–107
Weetman AP (2000) Graves’ disease. N Engl J Med 343:1236–1248
Vaidya B, Pearce S (2004) The emerging role of the CTLA-4 gene in autoimmune endocrinopathies. Eur J Endocrinol 150:619–626
Cooper DS (2002) Subclinical hypothyroidism. N Engl J Med 345:260–265
Betterle C, Callegari GP, Presotto F et al (1987) Thyroid autoantibodies: a good marker for the study of symptomless autoimmune thyroiditis. Acta Endocrinol (Copenh) 114:321–327
Yoshida H, Amino N, Yagawa K et al (1978) Association of serum anti-thyroid antibodies with lymphocytic infiltration of the thyroid gland: studies on seventy autopsied cases. J Clin Endocrinol Metab 46:858–862
Tran A, Quaranta JF, Benzaken S et al (1993) High prevalence of thyroid autoantibodies in a prospective series of patients with chronic hepatitis C before interferon therapy. Hepatology 18:253–257
Pateron D, Hartmann DJ, Jouanolle DV, Beaugrand M (1993) Latent autoimmune thyroid disease in patients with chronic HCV hepatitis. J Hepatol 17:417–419
Watanabe U, Hashimoto E, Hisamitsu T et al (1994) The risk factor for development of thyroid disease during interferon-alpha therapy for chronic hepatitis C. Am J Gastroenterol 89:399–403
Boadas J, Rodriguez-Espinosa J, Enriquez J et al (1995) Prevalence of thyroid autoantibodies is not increased in blood donors with hepatitis C virus infection. J Hepatol 22:611–615
Carella C, Amato G, Biondi B et al (1995) Longitudinal study of antibodies against thyroid in patients undergoing interferon-α therapy for HCV chronic hepatitis. Horm Res 44:110–114
Preziati D, La Rosa L, Covini G et al (1995) Autoimmunity and thyroid function in patients with chronic active hepatitis treated with recombinant interferon alpha-2. Eur J Endocrinol 132:587–593
Roti E, Minelli R, Giuberti T et al (1996) Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alpha. Am J Med 101:482–487
Loviselli A, Oppo A, Velluzzi F et al (1999) Independent expression of serological markers of thyroid autoimmunity and hepatitis virus C infection in the general population: results of a community-based study in north-western Sardinia. J Endocrinol Invest 22:660–665
Metcalfe RA, Ball G, Kudesia G, Weetman AP (1997) Failure to find an association between hepatitis C virus and thyroid autoimmunity. Thyroid 22:660–665
Floreani A, Chiaramonte M, Greggio NA et al (1998) Organ-specific autoimmunity and genetic predisposition in interferon-treated HCV-related chronic hepatitis patients. Ital J Gastroenterol Hepatol 30:71–76
Fernandez-Soto L, Gonzales A, Escobar-Jimenez F et al (1998) Increased risk of autoimmune thyroid disease in hepatitis C vs hepatitis B before, during and after discontinuing interferon therapy. Arch Intern Med 158:1445–1448
Carella C, Mazziotti G, Morisco F et al (2002) The addition of ribavirin to interferon-alpha therapy with hepatitis C virus-related chronic hepatitis does not modify the thyroid autoantibody pattern but increases the risk of developing hypothyroidism. Eur J Endocrinol 146:743–749
Ganne-Carrie N, Medini A, Coderc E et al (2000) Latent autoimmune thyroiditis in untreated patients with HCV chronic hepatitis: a case-control study. J Autoimmun 14:189–193
Zusinaite E, Metskula K, Salupere R (2005) Autoantibodies and hepatitis C virus genotypes in chronic hepatitis C patients in Estonia. World J Gastroenterol 11:488–494
Gehring S, Kullmer U, Koeppelmann S et al (2006) Prevalence of autoantibodies and the risk of autoimmune thyroid disease in children with chronic hepatitis C virus infection treated with interferon-α. World J Gastroenterol 12:5787–5792
Quaranta JR, Tran A, Regnier D et al (1993) High prevalence of antibodies to hepatitis C virus (HCV) in patients with anti-thyroid autoantibodies. J Hepatol 18:136–138
Marcellin P, Pouteau M, Benhamou JP (1995) Hepatitis C virus infection, alpha interferon therapy and thyroid dysfunction. J Hepatol 22:364–369
Floreani A, Betterle C, Carderi I, Arsita-Research Group et al (2006) Is hepatitis C virus a risk factor for thyroid autoimmunity? J Viral Hepat 13:272–277
Marcellin P, Pouteau M, Renard P et al (1992) Sustained hypothyroidism induced by recombinant alpha interferon in patients with chronic hepatitis C. Gut 33:855–856
Baudin E, Marcellin P, Pouteau M et al (1993) Reversibility of thyroid dysfunction induced by recombinant alpha interferon in chronic hepatitis C. Clin Endocrinol 39:657–661
Imagawa A, Itoh N, Hanafusa T et al (1995) Autoimmune endocrine disease induced by recombinant interferon-alpha therapy for chronic active hepatitis. J Clin Endocrinol Metab 80:922–926
Marazuela M, Garcia-Buey L, Gonzalez-Fernandez B et al (1996) Thyroid autoimmune disorders in patients with chronic hepatitis C before and during interferon-α therapy. Clin Endocrinol 44:635–642
Carella C, Mazziotti G, Morisco F et al (2001) Long-term outcome of interferon-alpha-induced thyroid autoimmunity and prognostic influence of thyroid autoantibody pattern at the end of treatment. J Clin Endocrinol Metab 86:1925–1929
Oppenheim Y, Ban Y, Tomer Y (2004) Interferon induced autoimmune thyroid disease (AITD): a model for human autoimmunity. Autoimmun Rev 3:388–393
Mandac JC, Chaudhry S, Sherman KE, Tomer Y (2006) The clinical and physiological spectrum of interferon-α induced thyroiditis: toward a new classification. Hepatology 43:661–672
Costelloe SJ, Wassef N, Schulz J et al (2010) Thyroid dysfunction in a UK hepatitis C population treated with interferon-alpha and ribavirin combination therapy. Clin Endocrinol (Oxf) 73:249–256
Atkinson MA, Eisenbarth GS (2001) Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet 358:221–229
Simo R, Hernandez C, Genesca J, Jardi R, Mesa J (1996) High prevalence of hepatitis C virus infection in diabetic patients. Diabetes Care 19:998–1000
Nizar N, Zein NN (1998) Hepatitis C and diabetes mellitus: an ongoing controversy. Am J Gastroenterol 93:2320–2322
Everarth JA (2001) Confluences of epidemics: does hepatitis C cause type 2 diabetes? Hepatology 33:762–763
Mehta SH, Brancati FL, Sulkowski MS, Strathdee SA, Szklo M, Thomas DL (2000) Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the united states. Ann Intern Med 133:592–599
Di Cesare E, Previti M, Russo F et al (1996) Interferon-alpha therapy may induce insulin autoantibodies development in patients with chronic viral hepatitis. Dig Dis Sci 41:1672–1677
Imagawa A, Itoh N, Hanafusa T et al (1996) Antibodies to glutamic acid decarboxylase induced by interferon-alpha therapy for chronic viral hepatitis. Diabetologia 39:126
Hiéronimus S, Fredenrich A, Tran A et al (1997) Antibodies to GAD in chronic hepatitis C patients. Diabetes Care 20:1044
Piquer S, Hernandez C, Enriquez J et al (2001) Islet cell and thyroid antibody in patients with hepatitis C virus infection: effect of treatment with interferon. J Lab Clin Med 137:38–42
Wesche B, Jaechel E, Trautwein C et al (2001) Induction of autoantibodies to adrenal cortex and pancreatic islet cells by interferon alpha therapy for chronic hepatitis C. Gut 48:378–383
Wasmuth HB, Stolte C, Geier A, Gartung C, Matern S (2001) Induction of multiple autoantibodies to islet cell antigens during treatment with interferon alpha for chronic hepatitis C. Gut 49:596–597
Fabris P, Floreani A, Tositti G et al (2003) Review article: type 1 diabetes mellitus in patients with chronic hepatitis C before and after interferon therapy. Aliment Pharmacol Ther 18:549–558
Devendra D, Eisenbarth GS (2004) Interferon alpha – a potential link in the pathogenesis of viral-induced type 1 diabetes and autoimmunity. Clin Immunol 111:225–233
Fabris P, Betterle C, Floreani A et al (1992) Development of type 1 diabetes mellitus during alpha-interferon therapy for chronic HCV hepatitis. Lancet 340:548
Fattovich G, Giustina G, Favarato S, Ruol A (1996) A survey of adverse events in 11,241 patients with chronic viral hepatitis treated with alpha interferon. J Hepatol 24:38–47
Okanoue T, Sakamoto S, Itoh Y et al (1996) Side effects of high-dose interferon therapy for chronic hepatitis. J Hepatol 25:283–291
Cozzolongo R, Betterle C, Fabris P et al (2006) Onset of type 1 diabetes mellitus during peginterferon alpha-2b plus ribavirin treatment for chronic hepatitis C. Eur J Gastroenterol Hepatol 18:689–692
Soultati A, Dourakis S, Alexopoulou A et al (2007) SimulÂtaneous development of diabetic ketoacidosis and Âhashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C. World J Gastroenterol 13:1292–1294
Tanaka J, Sugimoto K, Shiraki K et al (2008) Type 1 diabetes mellitus provoked by peginterferon α-2b plus ribavirin treatment for chronic hepatitis C. Intern Med 47:747–749
Ogihara T, Katagiri H, Yamada T et al (2009) Peginterferon (PEG-IFN) plus ribavirin combination therapy, but neither interferon nor PGE-IFN alone, induced type 1 diabetes in a patient with chronic hepatitis C. Intern Med 48:1387–1390
Yamazaki M, Sato A, Takeda T, Komatsu M (2010) Distinct clinical courses in type 1 diabetes mellitus induced by peg-interferon-alpha treatment for chronic hepatitis C. Intern Med 49:403–407
Muraishi K, Sasaki Y, Kato T et al (2011) Classification and characterization of interferon-related diabetes mellitus in Japan. Hepatol Res 41:184–188
Fabbri C, Jaboli F, Giovanelli S et al (2003) Gastric autoimmune disorders in patients with chronic hepatitis C before, during and after interferon-alpha therapy. World J Gastroenterol 9:1487–1490
Andrès E, Loukili NH, Ben Abdelghani M, Noel E (2004) Pernicious anemia associated with interferon-alpha therapy and chronic hepatitis C infection. Clin Gastroenterol 38:382–383
Durante-Mangoni E, Iardino P, Resse M et al (2004) Silent celiac disease in chronic hepatitis C – impact of interferon treatment on the disease onset and clinical outcome. J Clin Gastroenterol 38:901–905
Ruggeri C, La Masa AT, Rudi S et al (2008) Celiac disease and non-organ-specific autoantibodies in patients with chronic hepatitis C virus infection. Dig Dis Sci 53:2151–2155
Ramos-Casals M, Muñoz S, Medina F et al (2009) HISPAMEC Study Group. Systemic autoimmune diseases in patients with hepatitis C virus infection: characterization of 1020 cases (The HISPAMEC Registry). J Rheumatol 36:1442–1448
Arrieta JJ, Rodriguez-Inigo E, Ortiz-Movilla N et al (2001) In situ detection of hepatitis C virus RNA in salivary glands. Am J Pathol 158:259–264
Agnello V, De Rosa FG (2004) Extra-hepatic disease manifestations of HCV infection: some current issues. J Hepatol 40:341–352
Williams MJ, Lawson A, Neal KR, on behalf of the Trent HCV Group et al (2009) Autoantibodies in chronic hepatitis C virus infection and their association with disease profile. J Viral Hepat 16:325–333
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Betterle, C., Presotto, F. (2012). Organ-Specific Autoimmunity in HCV-Positive Patients. In: Dammacco, F. (eds) HCV Infection and Cryoglobulinemia. Springer, Milano. https://doi.org/10.1007/978-88-470-1705-4_5
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