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Chronic hepatitis C viral infection among SLE patients: the significance of coexistence

  • Novel Aspects in Lupus, 2017
  • Published:
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The association between viral infection and autoimmune diseases is an established phenomenon in medicine. Hepatitis C viral infection is known to have such an association; however, its association with systemic lupus erythematosus has not been studied in a real life study driven from a large national database. The objective of this study was to investigate the association between SLE and chronic hepatitis C viral infection. Patients with SLE were compared with age- and sex-matched controls regarding the proportion chronic HCV infection. Chi-square and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services in Israel. There was a significant higher proportion of hepatitis C viral infection in SLE patients as compared to controls (1.06 and 0.39%, respectively; p < 0.001). A significant association was also observed among patients of higher socioeconomic status. In a multivariate logistic regression analysis, SLE was significantly associated with hepatitis C viral infection (OR = 2.07, 95% CI = 1.46–2.90). To conclude, Patients with SLE have a greater proportion of chronic HCV infection than matched controls.

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  1. Tsokos GC. Systemic lupus erythematosus. N Engl J Med. 2011;365(22):2110–21.

    Article  CAS  PubMed  Google Scholar 

  2. Yaniv G, Twig G, Shor DB, Furer A, Sherer Y, Mozes O, et al. A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients. Autoimmun Rev. 2015;14(1):75–9.

    Article  CAS  PubMed  Google Scholar 

  3. Dahan S, Shor DB, Comaneshter D, Tekes-Manova D, Shovman O, Amital H, et al. All disease begins in the gut: celiac disease co-existence with SLE. Autoimmun Rev. 2016;15(8):848–53.

    Article  PubMed  Google Scholar 

  4. Shor DB, Dahan S, Comaneshter D, Cohen AD, Amital H. Does inflammatory bowel disease coexist with systemic lupus erythematosus? Autoimmun Rev 2016.

  5. Tiosano S, Farhi A, Watad A, Grysman N, Stryjer R, Amital H et al. Schizophrenia among patients with systemic lupus erythematosus: population-based cross-sectional study. Epidemiol Psychiatr Sci 2016;1–6.

  6. Watad A, Mahroum N, Whitby A, Gertel S, Comaneshter D, Cohen AD, et al. Hypothyroidism among SLE patients: case-control study. Autoimmun Rev. 2016;15(5):484–6.

    Article  CAS  PubMed  Google Scholar 

  7. Watad A, Cohen AD, Comaneshter D, Tekes-Manova D, Amital H. Hyperthyroidism association with SLE, lessons from real-life data—a case-control study. Autoimmunity. 2016;49(1):17–20.

    Article  PubMed  Google Scholar 

  8. Harley JB, Harley IT, Guthridge JM, James JA. The curiously suspicious: a role for Epstein-Barr virus in lupus. Lupus. 2006;15(11):768–77.

    Article  CAS  PubMed  Google Scholar 

  9. James JA, Robertson JM. Lupus and Epstein-Barr. Curr Opin Rheumatol. 2012;24(4):383–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kang I, Quan T, Nolasco H, Park SH, Hong MS, Crouch J, et al. Defective control of latent Epstein-Barr virus infection in systemic lupus erythematosus. J Immunol. 2004;172(2):1287–94.

    Article  CAS  PubMed  Google Scholar 

  11. Zandman-Goddard G, Berkun Y, Barzilai O, Boaz M, Blank M, Ram M, et al. Exposure to Epstein-Barr virus infection is associated with mild systemic lupus erythematosus disease. Ann N Y Acad Sci. 2009;1173:658–63.

    Article  CAS  PubMed  Google Scholar 

  12. Gendelman O, Mahroum N, Comaneshter D, Rotman-Pikielny P, Cohen AD, Amital H et al. Hepatitis B carrier state among SLE patients: case-control study. Immunol Res 2016.

  13. Vrielink H, van der Poel CL, Reesink HW, Zaaijer HL, Scholten E, Kremer LC, et al. Look-back study of infectivity of anti-HCV ELISA-positive blood components. Lancet. 1995;345(8942):95–6.

    Article  CAS  PubMed  Google Scholar 

  14. Donahue JG, Munoz A, Ness PM, Brown Jr DE, Yawn DH, McAllister Jr HA, et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med. 1992;327(6):369–73.

    Article  CAS  PubMed  Google Scholar 

  15. El SY, Hemida K, Rafik M, Al SR, Ali-Eldin ZA, GadAllah S. Detection of occult hepatitis C virus among healthy spouses of patients with HCV infection. J Med Virol. 2015;87(3):424–7.

    Article  Google Scholar 

  16. Aykin N, Cevik F, Demirturk N, Demirdal T, Orhan S, Naz H. Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C. Scand J Infect Dis. 2008;40(6–7):533–7.

    Article  CAS  PubMed  Google Scholar 

  17. Mohd HK, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333–42.

    Article  Google Scholar 

  18. Rosen HR. Clinical practice. Chronic hepatitis C infection. N Engl J Med. 2011;364(25):2429–38.

    Article  CAS  PubMed  Google Scholar 

  19. Alter MJ, Kuhnert WL, Finelli L. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. Centers for Disease Control and Prevention. MMWR Recomm Rep 2003; 52(RR-3):1–13, 15.

  20. Amital H, Rubinow A, Langevitz P, Shoenfeld Y. Refractory leg infection as an inducer of the catastrophic antiphospholipid syndrome. Ann Rheum Dis. 2004;63(8):1004.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Amital H, Govoni M, Maya R, Meroni PL, Ori B, Shoenfeld Y, et al. Role of infectious agents in systemic rheumatic diseases. Clin Exp Rheumatol. 2008;26(1 Suppl 48):S27–32.

    CAS  PubMed  Google Scholar 

  22. Arnson Y, Amital H, Guiducci S, Matucci-Cerinic M, Valentini G, Barzilai O, et al. The role of infections in the immunopathogensis of systemic sclerosis—evidence from serological studies. Ann N Y Acad Sci. 2009;1173:627–32.

    Article  CAS  PubMed  Google Scholar 

  23. Barzilai O, Ram M, Shoenfeld Y. Viral infection can induce the production of autoantibodies. Curr Opin Rheumatol. 2007;19(6):636–43.

    Article  CAS  PubMed  Google Scholar 

  24. Belizna CC, Hamidou MA, Levesque H, Guillevin L, Shoenfeld Y. Infection and vasculitis. Rheumatology (Oxford). 2009;48(5):475–82.

    Article  Google Scholar 

  25. Plot L, Amital H, Barzilai O, Ram M, Bizzaro N, Shoenfeld Y. Infections may have a protective role in the etiopathogenesis of celiac disease. Ann N Y Acad Sci. 2009;1173:670–4.

    Article  CAS  PubMed  Google Scholar 

  26. Ram M, Shoenfeld Y. Hepatitis B: infection, vaccination and autoimmunity. Isr Med Assoc J. 2008;10(1):61–4.

    PubMed  Google Scholar 

  27. Draborg AH, Jacobsen S, Westergaard M, Mortensen S, Larsen JL, Houen G, et al. Reduced response to Epstein-Barr virus antigens by T-cells in systemic lupus erythematosus patients. Lupus Sci Med. 2014;1(1):e000015.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Filimonova RG, Bogomolova NN, Nevraeva EG, Tareyeva IE. Measles virus genome in patients with lupus nephritis and glomerulonephritis. Nephron. 1994;67(4):488–9.

    Article  CAS  PubMed  Google Scholar 

  29. Liu X, Jiao Y, Cui B, Gao X, Xu J, Zhao Y. The potential protective role of hepatitis B virus infection in pristane-induced lupus in mice. Lupus. 2016;25(11):1180–9.

    Article  CAS  PubMed  Google Scholar 

  30. Ram M, Anaya JM, Barzilai O, Izhaky D, Porat Katz BS, Blank M, et al. The putative protective role of hepatitis B virus (HBV) infection from autoimmune disorders. Autoimmun Rev. 2008;7(8):621–5.

    Article  CAS  PubMed  Google Scholar 

  31. Palazzi C, D'Angelo S, Olivieri I. Hepatitis C virus-related arthritis. Autoimmun Rev. 2008;8(1):48–51.

    Article  PubMed  Google Scholar 

  32. Sousa GM, Oliveira RC, Pereira MM, Parana R, Sousa-Atta ML, Atta AM. Autoimmunity in hepatitis C virus carriers: involvement of ferritin and prolactin. Autoimmun Rev. 2011;10(4):210–3.

    Article  CAS  PubMed  Google Scholar 

  33. Rosenthal E, Cacoub P. Extrahepatic manifestations in chronic hepatitis C virus carriers. Lupus. 2015;24(4–5):469–82.

    Article  CAS  PubMed  Google Scholar 

  34. Krajewska M, Rukasz D, Jakuszko K, Augustyniak-Bartosik H, Penar J, Bednarz Z, et al. Hepatitis C-associated glomerulonephritis mimicking systemic lupus erythematosus. Scand J Rheumatol. 2015;44(4):343–4.

    Article  CAS  PubMed  Google Scholar 

  35. Ramos-Casals M, Garcia-Carrasco M, Cervera R, Rosas J, Trejo O, de la Red G, et al. Hepatitis C virus infection mimicking primary Sjogren syndrome. A clinical and immunologic description of 35 cases. Medicine (Baltimore). 2001;80(1):1–8.

    Article  CAS  Google Scholar 

  36. Ramos-Casals M, Jara LJ, Medina F, Rosas J, Calvo-Alen J, Mana J, et al. Systemic autoimmune diseases co-existing with chronic hepatitis C virus infection (the HISPAMEC Registry): patterns of clinical and immunological expression in 180 cases. J Intern Med. 2005;257(6):549–57.

    Article  CAS  PubMed  Google Scholar 

  37. El GA, El ZB, Gheith R, Sheba H, Abdel MG, El GK. Prevalence and clinical presentations of hepatitis C virus among patients admitted to the rheumatology ward. Rheumatol Int. 2012;32(9):2691–5.

    Article  Google Scholar 

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Correspondence to Howard Amital.

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The study was approved by the ethical committee of CHS, located at the Soroka Medical Center, Beer Sheva, Israel.

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Mahroum, N., Hejly, A., Tiosano, S. et al. Chronic hepatitis C viral infection among SLE patients: the significance of coexistence. Immunol Res 65, 477–481 (2017).

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