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. 1991 Oct;32(10):1198–1200. doi: 10.1136/gut.32.10.1198

Severe chronic active hepatitis (autoimmune type) mimicked by coinfection of hepatitis C and human immunodeficiency viruses.

L Berk 1, S W Schalm 1, R A Heijtink 1
PMCID: PMC1379385  PMID: 1955176

Abstract

Severe chronic active hepatitis, defined as the presence of a fivefold increase in serum aminotransferases and a twofold rise in gamma globulin for at least 10 weeks, is considered a progressive immunological liver disease requiring corticosteroid treatment, particularly when serum autoantibodies and a severe lymphoplasmacellular periportal infiltrate are found in the liver biopsy specimen. A 38 year old man who fulfilled the criteria for severe chronic active hepatitis is described. His sex, his homosexuality, and the presence of antibodies against HIV, however, led to the suspicion of a coinfection with hepatitis C virus (HCV) rather than autoimmune disease. The rapid and complete response to alpha interferon treatment and a recently available positive antibody test for HCV supported this view. These findings indicate that a HCV related chronic active hepatitis can present as the severe autoimmune type of chronic active hepatitis. Moreover, as in HBV infection, the response to treatment differs from that of autoimmune severe chronic active hepatitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cook G. C., Mulligan R., Sherlock S. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis. Q J Med. 1971 Apr;40(158):159–185. doi: 10.1093/oxfordjournals.qjmed.a067264. [DOI] [PubMed] [Google Scholar]
  2. Davis G. L., Balart L. A., Schiff E. R., Lindsay K., Bodenheimer H. C., Jr, Perrillo R. P., Carey W., Jacobson I. M., Payne J., Dienstag J. L. Treatment of chronic hepatitis C with recombinant interferon alfa. A multicenter randomized, controlled trial. Hepatitis Interventional Therapy Group. N Engl J Med. 1989 Nov 30;321(22):1501–1506. doi: 10.1056/NEJM198911303212203. [DOI] [PubMed] [Google Scholar]
  3. Geall M. G., Schoenfield L. J., Summerskill W. H. Classification and treatment of chronic active liver disease. Gastroenterology. 1968 Dec;55(6):724–729. [PubMed] [Google Scholar]
  4. Geubel A. P., Baggenstoss A. H., Summerskill W. H. Responses to treatment can differentiate chronic active liver disease with cholangitic features from the primary biliary cirrhosis syndrome. Gastroenterology. 1976 Sep;71(3):444–449. [PubMed] [Google Scholar]
  5. Hoofnagle J. H., Mullen K. D., Jones D. B., Rustgi V., Di Bisceglie A., Peters M., Waggoner J. G., Park Y., Jones E. A. Treatment of chronic non-A,non-B hepatitis with recombinant human alpha interferon. A preliminary report. N Engl J Med. 1986 Dec 18;315(25):1575–1578. doi: 10.1056/NEJM198612183152503. [DOI] [PubMed] [Google Scholar]
  6. LaRusso N. F., Wiesner R. H., Ludwig J., MacCarty R. L. Current concepts. Primary sclerosing cholangitis. N Engl J Med. 1984 Apr 5;310(14):899–903. doi: 10.1056/NEJM198404053101407. [DOI] [PubMed] [Google Scholar]
  7. Martin P., Di Bisceglie A. M., Kassianides C., Lisker-Melman M., Hoofnagle J. H. Rapidly progressive non-A, non-B hepatitis in patients with human immunodeficiency virus infection. Gastroenterology. 1989 Dec;97(6):1559–1561. doi: 10.1016/0016-5085(89)90405-8. [DOI] [PubMed] [Google Scholar]
  8. McFarlane I. G., Smith H. M., Johnson P. J., Bray G. P., Vergani D., Williams R. Hepatitis C virus antibodies in chronic active hepatitis: pathogenetic factor or false-positive result? Lancet. 1990 Mar 31;335(8692):754–757. doi: 10.1016/0140-6736(90)90870-b. [DOI] [PubMed] [Google Scholar]
  9. Murray-Lyon I. M., Stern R. B., Williams R. Controlled trial of prednisone and azathioprine in active chronic hepatitis. Lancet. 1973 Apr 7;1(7806):735–737. doi: 10.1016/s0140-6736(73)92125-9. [DOI] [PubMed] [Google Scholar]
  10. Schalm S. W., Summerskill W. H., Gitnick G. L., Elveback L. R. Contrasting features and responses to treatment of severe chronic active liver disease with and without hepatitis BS antigen. Gut. 1976 Oct;17(10):781–786. doi: 10.1136/gut.17.10.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Schnittman S. M., Lane H. C., Higgins S. E., Folks T., Fauci A. S. Direct polyclonal activation of human B lymphocytes by the acquired immune deficiency syndrome virus. Science. 1986 Sep 5;233(4768):1084–1086. doi: 10.1126/science.3016902. [DOI] [PubMed] [Google Scholar]
  12. Soloway R. D., Summerskill W. H., Baggenstoss A. H., Geall M. G., Gitnićk G. L., Elveback I. R., Schoenfield L. J. Clinical, biochemical, and histological remission of severe chronic active liver disease: a controlled study of treatments and early prognosis. Gastroenterology. 1972 Nov;63(5):820–833. [PubMed] [Google Scholar]

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