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World J Gastroenterol. Mar 21, 2014; 20(11): 2962-2970
Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2962
Useful biomarkers for assessment of hepatitis C virus infection-associated autoimmune disorders
Deng-Ho Yang, Ling-Jun Ho, Jenn-Haung Lai
Deng-Ho Yang, Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung 411, Taiwan
Deng-Ho Yang, Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Ling-Jun Ho, Institute of Cellular and System Medicine, National Health Research Institute, Zhunan 350, Taiwan
Jenn-Haung Lai, Graduate Institute of Medical Science, National Defense Medical Center, Taipei 114, Taiwan
Jenn-Haung Lai, Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
Author contributions: Yang DH drafted and wrote the article; Ho LJ revised the paper; and Lai JH wrote and approved the final version.
Supported by (In part) the National Science Council, NSC 101-2314-B-182A-103-MY3; and Chang Gung Memorial Hospital, CMRPG3B1751E
Correspondence to: Jenn-Haung Lai, MD, PhD, Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fusing St., Gueishan Township, Taoyuan 333, Taiwan. laiandho@gmail.com
Telephone: +886-2-87927135 Fax: +886-2-87927136
Received: September 25, 2013
Revised: November 10, 2013
Accepted: December 12, 2013
Published online: March 21, 2014
Processing time: 173 Days and 16.3 Hours
Abstract

During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestations of autoimmune disorders may occur, including arthralgia/arthritis, sicca complex, purpura, cutaneous ulcer, and thyroid dysfunction. In addition, the prevalence of circulating autoantibodies is high among patients with HCV infection. Commonly detected autoantibodies in HCV-infected patients include rheumatoid factor, antinuclear antibody, anti-SSA/anti-SSB antibody, cryoglobulin, antineutrophil cytoplasmic antibody, anti-smooth muscle antibody, anti-liver and anti-thyroid autoantibodies. These autoantibodies may be associated with underlying autoimmune disorders or liver inflammation in HCV infection. A possible reason for antibody production is overactivation and proliferation of B lymphocytes, via the interaction with the surface protein of HCV. Because immunotherapy can cause HCV flare-up or liver damage, overdiagnosis of HCV-related autoimmune symptoms as primary autoimmune disorders should be avoided. This review describes biomarkers that are useful in clinically evaluating autoimmune manifestations and disorders associated with HCV infection.

Keywords: Hepatitis C virus; Autoantibody; Autoimmune; Biomarker; Cytokine

Core tip: Patients with hepatitis C virus (HCV) infection may develop a variety of immunological manifestations simulating those observed in patients with autoimmune disorders. Concurrently, many laboratory abnormalities commonly present in autoimmune disorders may be detected. Overactivation and proliferation of B lymphocytes, via the interaction with the surface protein of HCV, contributes in part to these abnormalities. These clinical and laboratory findings can potentially mid-lead to the diagnosis of primary autoimmune disorders and result in inappropriate therapy. This review addresses the importance of several clinical and laboratory biomarkers and their usefulness in distinguishing HCV infection-related from primary autoimmune disorder-related etiologies.