Systemic Autoimmune Diseases in Patients with Hepatitis C Virus Infection: Characterization of 1020 Cases (The HISPAMEC Registry)

ArticleinThe Journal of Rheumatology 36(7):1442-8 · May 2009with21 Reads
DOI: 10.3899/jrheum.080874 · Source: PubMed
Abstract
To describe the clinical and immunologic characteristics of a large series of patients with systemic autoimmune diseases (SAD) associated with chronic hepatitis C virus (HCV) infection. The HISPAMEC Registry is a multicenter international study group dedicated to collecting data on patients diagnosed with SAD with serological evidence of chronic HCV infection. The information sources are cases reported by physicians of the HISPAMEC Study Group and periodic surveillance of reported cases by a Medline search updated up to December 31, 2007. One thousand twenty HCV patients with SAD were included in the registry. Patients were reported from Southern Europe (60%), North America (15%), Asia (14%), Northern Europe (9%), South America (1%), and Australia (1%). Countries reporting the most cases were Spain (236 cases), France (222 cases), Italy (144 cases), USA (120 cases), and Japan (95 cases). The most frequently reported SAD were Sjögren's syndrome (SS; 483 cases), rheumatoid arthritis (RA; 150 cases), systemic lupus erythematosus (SLE; 129 cases), polyarteritis nodosa (78 cases), antiphospholipid syndrome (59 cases), inflammatory myopathies (39 cases), and sarcoidosis (28 cases). Twenty patients had 2 or more SAD. Epidemiological data were available in 677 cases. Four hundred eighty-seven (72%) patients were female and 186 (28%) male, with a mean age of 49.5 +/- 1.0 years at SAD diagnosis and 50.5 +/- 1.1 years at diagnosis of HCV infection. The main immunologic features were antinuclear antibody (ANA) in 61% of patients, rheumatoid factor (RF) in 57%, hypocomplementemia in 52%, and cryoglobulins in 52%. The main differential aspect between primary and HCV-related SAD was the predominance of cryoglobulinemic-related markers (cryoglobulins, RF, hypocomplementemia) over specific SAD-related markers (anti-ENA antibodies, anti-dsDNA, anti-cyclic citrullinated peptide) in patients with HCV. In the selected cohort, the SAD most commonly reported in association with chronic HCV infection were SS (nearly half the cases), RA and SLE. Nearly two thirds of SAD-HCV cases were reported from the Mediterranean area. In these patients, ANA, RF and cryoglobulins are the predominant immunological features.
    • "A significant overall association between HCV infection and SS was observed in a recent meta-analysis [11]. There is increasing evidence from experimental [30], virological [31,32], and clinical studies [13,33,34] suggesting that HCV and SS may share some overlapping etiological characteristics. Casals and his colleagues proposed the term SS " secondary to HCV " (SS-HCV) to implicate the development of SS in a particular subset of HCV patients [6]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective The association between Sjögren’s syndrome (SS) and chronic hepatitis virus infection is inconclusive. Hepatitis B (HBV) and hepatitis C virus (HCV) infections are highly prevalent in Taiwan. We used a population-based case-control study to evaluate the associations between SS and HBV and HCV infections. Materials and Methods We identified 9,629 SS patients without other concomitant autoimmune diseases and 38,516 sex- and age-matched controls without SS from the Taiwan National Health Insurance claims data between 2000 and 2011. We utilized multivariate logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between SS and HBV and HCV infections. Sex- and age-specific (<55 and ≥55 years) risks of SS were evaluated. Results The risk of SS was higher in patients with HCV than in those without chronic viral hepatitis (OR = 2.49, 95% CI = 2.16–2.86). Conversely, HBV infection was not associated with SS (OR = 1.10, 95% CI = 0.98–1.24). Younger HCV patients were at a higher risk for SS (<55 years: OR = 3.37, 95% CI = 2.62–4.35; ≥55 years: OR = 2.20, 95% CI = 1.84–2.62). Men with HCV were at a greater risk for SS (women: OR = 2.26, 95% CI = 1.94–2.63; men: OR = 4.22, 95% CI = 2.90–6.16). Only men with chronic HBV exhibited a higher risk of SS (OR = 1.61, 95% CI = 1.21–2.14). Conclusion HCV infection was associated with SS; however, HBV only associated with SS in men.
    Full-text · Article · Aug 2016
    • "The features that mainly mark VH1-69 autoreactivity profile are basically its framework amino acid sequences and the abnormal CDR3 length. These characteristics are mainly responsible for the binding to hydrophobic pockets on the viral envelope and therefore for VH1-69-related neutralizing activity but, on the other side, are burdened by the potential cross-recognition of self-antigens (host cell membranes) leading to autoreactivity phenomena [46] (Table 1). A practical example of infection-related autoimmune diseases is type II mixed cryoglobulinemia (MCII), a clinical syndrome of systemic inflammation characterized by systemic vasculitis caused by the deposition of immune complexes on small vessel walls [47] . "
    Dataset · Mar 2016 · Journal of Clinical Medicine Research
    • "Hepatitis C virus is associated with many extrahepatic disease manifestations, autoimmune phenomena, and frank autoimmune diseases in almost half of chronic carriers. It has been reported frequently in association with Sjogren syndrome, rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa, antiphospholipid syndrome, inflammatory myopathies, and sarcoidosis[31,33]. DENV has been recently found to show molecular mimicry with coagulation factors able to induce the production of autoantibodies with biological effects similar to those due to anti-thrombin antibodies, which inhibit thrombin activity and enhance fibrinolysis, and may lead to the Dengue hemorrhagic fever and shock syndrome[34]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Myasthenia gravis (MG) is an autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal muscles. Specific auto-antibodies against acetylcholine receptor (AChR) are present in the majority of MG patients, although the main cause behind its development still remains unclear. Recently MG development following West Nile virus (WNV) infection has been described in patients without any earlier evidence of MG. It is known that infectious agents trigger immune response and occasionally initiate autoimmune disease. WNV, the causative agent of both benign illness and neuroinvasive disease, has become endemic in many countries in all continents. Methods: In the present study, 29 patients (15 males and 14 females, 19 - 78 years old) with confirmed diagnosis of MG and elevated levels of AChR autoantibodies were screened for the presence of serum anti-WNV antibodies and compared to a similar population affected by different autoimmune diseases. Indirect immunofluorescent antibody technique was used to evaluate the reaction of patients' sera on cells infected by WNV. Results: Positive fluorescent signals for anti-WNV IgG were obtained in 17% of MG patients, although no clinical manifestations related to WNV infection were reported. These results are in agreement with previous data and appear of great interest in the understanding of the pathogenic autoimmune mechanisms at the bases of MG development. Conclusion: As already observed in other human autoimmune diseases, pathogen-triggered autoimmunity could be involved in MG by breaking immunological self-tolerance through possible mechanisms of molecular mimicry between virus proteins and AChR subunits. In predisposed individuals, WNV infection could also represent an additional risk factor to initiate MG.
    Full-text · Article · Feb 2016
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