Gastrointestinal Infections

Effects of Sustained Virologic Response to HCV Therapy on Autoimmune Disease Incidence

Bradley van Paridon
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PCT manifests when hepatic UROD activity is <20% of normal.1 As porphyrins accumulate in the liver, they are transported to the skin, leading to phototoxicity as light exposure causes the porphyrins to release photons.1 Subsequently, patients develop blisters on sun-exposed areas of their skin, particularly the hands, face, neck, and forearms. These areas are also prone to blisters and peeling after mild trauma. When the lesions scar, they may resemble systemic scleroderma. In some cases, lesions become painful. Patients may also have abnormal hair growth, skin thickening, and hypopigmentation. PCT is diagnosed when elevated porphyrins are detected in the plasma. Urine and fecal studies can confirm the diagnosis when they show similarly elevated porphyrin levels, with urine typically showing excess uroporphyrin and 7-carboxylate porphyrin and feces showing excess isocoproporphyrin.6 Patients with a PCT diagnosis should be tested for HCV if their status is unknown. Photo Credit: Dr Harout Tanielian/Science Source.

PCT manifests when hepatic UROD activity is <20% of normal.1 As porphyrins accumulate in the liver, they are transported to the skin, leading to phototoxicity as light exposure causes the porphyrins to release photons.1 Subsequently, patients develop blisters on sun-exposed areas of their skin, particularly the hands, face, neck, and forearms. These areas are also prone to blisters and peeling after mild trauma. When the lesions scar, they may resemble systemic scleroderma. In some cases, lesions become painful. Patients may also have abnormal hair growth, skin thickening, and hypopigmentation.

PCT is diagnosed when elevated porphyrins are detected in the plasma. Urine and fecal studies can confirm the diagnosis when they show similarly elevated porphyrin levels, with urine typically showing excess uroporphyrin and 7-carboxylate porphyrin and feces showing excess isocoproporphyrin.6 Patients with a PCT diagnosis should be tested for HCV if their status is unknown.

Photo Credit: Dr Harout Tanielian/Science Source.

Patients with chronic hepatitis C (HCV) achieving sustained virologic response to pegylated interferon plus ribavirin therapy did not exhibit an effect on the incidence of systemic lupus erythematosus (SLE) or rheumatoid arthritis.

Patients with chronic hepatitis C (HCV) who showed sustained virologic response to pegylated interferon plus ribavirin therapy did not exhibit an effect on the incidence of systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) compared with patients who did not have sustained virologic response. This is according to data published in Scientific Reports.

Chronic HCV has had well documented associated with HCV-related systemic, extrahepatic manifestations, including autoimmune diseases such as SLE, RA, diabetes, mellitus, and mixed cryoglobulinemia. One major previous study reported that antiviral treatment with pegylated interferon plus ribavirin did not decrease the incidence of autoimmune diseases, but the effects of baseline characteristics, virologic profiles, and therapeutic outcome on autoimmune diseases are unknown.

Therefore, researchers conducted this nationwide cohort study to elucidate the effects of baseline factors and therapeutic outcome of pegylated interferon plus ribavirin therapy on the incidence of autoimmune diseases in patients with chronic HCV. A total of 12,770 patients with chronic HCV receiving pegylated interferon plus ribavirin for at least 4 weeks between January 2003 and December 2015 were enrolled. Patient data was then linked to the Taiwan National Health Insurance Research Database for studying the development of 10 autoimmune diseases.

The mean follow-up duration in the study was 5.3 ± 2.9 years with a total of 67,930 person-years. The sustained virologic response rate at 24 weeks after pegylated interferon plus ribavirin treatment was 76.2%. Among patients who demonstrated virologic response, results showed a lower body mass index (BMI), HCV RNA level, and FIB-4 index, as well as a higher rate of rapid virologic response, and higher levels of platelets, aspartate transaminase and alanine transaminase.

The annual incidence of SLE and RA did not differ between patients who had sustained virologic response and those who did not. Due to there being few events, other autoimmune diseases could not be assessed. An independent predicator of the low incidence of SLE or RA was BMI ≥24 kg/m2 (hazard ratio, 0.40; 95% CI, 0.17-0.93; P = .034). In a subgroup analysis a sustained virologic response to pegylated interferon plus ribavirin therapy was not associated with the low incidence of SLE or RA.

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The study was limited by the low incidences of several autoimmune diseases. These included mixed cryoglobulinemia, chronic glomerulonephritis, autoimmune thyroiditis, lichen planus, Sjögren’s syndrome, immune thrombocytopenic purpura, autoimmune hemolytic anemia, and porphyria cutanea tarda. Also, while baseline virologic features, complete blood count, and biochemical data were collected, “the effect of baseline autoantibody profiles and their temporal changes on the incidence of autoimmune diseases remain unknown.” This therefore requires further investigation as does whether the eradication of HCV using direct acting antivirals has a differential effect on the incidence of autoimmune diseases.

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Investigators concluded that the HCV patients achieving sustained virologic response to pegylated interferon plus ribavirin therapy did not exhibit a low incidence of the 2 assessable autoimmune diseases compared with patients without sustained virologic response. However, baseline BMI ≥ 24 kg/m2 was an independent predictor of the low incidence.

Reference

Hsu WF, Chen CY, Tseng KC, et al. Sustained virological response to hepatitis C therapy does not decrease the incidence of systemic lupus erythematosus or rheumatoid arthritis [published online March 25, 2020]. Sci Rep. doi:10.1038/s41598-020-61991-3

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