Article Text

IMMUNOLOGICAL INVOLVEMENT IN CHRONIC VIRAL HEPATITIS
  1. D Pacurar1,
  2. G Lesanu1,
  3. D Oraseanu1,
  4. C Becheanu1
  1. 1Pediatric Department, Clinical Children Hospital, Bucharest, Romania

Abstract

Chronic hepatitis is a hepatic inflammatory process persisting over 6 months. In some cases is suggested autoimmune mechanism by the finding of antinuclear and anti-smooth muscle antibody in serum and by general involvement.

Materials and Methods This study takes in observation of 401 patients, admitted to hospital between 1996 and 2007 with chronic viral hepatitis (298 HBV, 13 HCV, 82 HDV, nine viral association) aged 9 months to 18 years. The patients were divided into two groups: patients with viral hepatitis treated with antiviral therapy: interferon, lamivudine or associated (314 children) and patients without antiviral therapy (88 patients). Some patients developed immunological disturbances (elevation of erythrocyte sedimentation rate, hypergammaglobulinaemia, autoimmune anaemia or thrombocytopaenia, presence of autoantibodies).

Results We tried to establish a connection between the autoimmune involvement and the antiviral therapy, the evolution of the disease and the treatment response. The autoimmune markers were found in 28 patients (9.24%) with chronic viral hepatitis treated with antiviral treatment and only in one patient (1.13%) without treatment. In order of frequency the autoimmune disturbances were rheumatoid factor, elevation of IgG and gamma globulin and less common antinuclear antibodies, anti-smooth muscle antibodies. In patients with autoimmune markers we observed clinical manifestations: anaemia, arthritis, rash.

Conclusions The most important question is: is antiviral therapy responsible for the autoimmune phenomena or is this secondary to chronic viral infection? Immunological involvement in chronic viral hepatitis influences therapeutic results and the evolution to cirrhosis.

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