Epidemiology, risk factors and prognosis of Interferon alpha induced thyroid disorders. A Prospective Clinical Study.

INTRODUCTION: Hepatitis C virus (HCV) infection is a worldwide problem and hepatitis, which is its natural unfavourable course, is still a challenge for hepatologist. At present, standards of treatment are changing from combined therapy with interferon alpha (IFN-α) and ribavirin to new antiviral drugs. The current classification divides interferon induced thyroid diseases (IITD) into two groups: autoimmune (Hashimoto disease, Graves disease, positive antithyroid autoantibodies in euthyroid patients) and non-autoimmune (destructive thyroiditis, non-autoimmune hypothyroidism). A common complication of cytokine therapy is the induction of antithyroid autoantibodies de novo without thyroid dysfunction. During therapeutic regimens combined with ribavirin, destructive thyroiditis with typical biphasic course is more common than in IFN-α monotherapy. Clinically, overt pathologies often have discrete symptoms, which cause diagnostic and therapeutic dilemmas. AIMS: The aim of this study was to estimate IITD occurrence, to find risk factors for IITD development. MATERIAL AND METHODS: The study group consisted of 66 patients treated for HCV infection. Before and during antiviral therapy, hormonal (TSH, fT4, fT3), immunological (thyroid autoantibodies), ultrasonographic and genetic (HLA-A2) parameters were evaluated. RESULTS: Hormonal disturbances were detected in 24.2% of patients; however, 43.9% of patients had positive thyroid autoantibodies (de novo) without hormonal imbalance. Multivariate analysis revealed the following: female sex, elevated TSH level, occurrence of anti-TPO autoantibodies (TPO-Ab), and increased blood velocity in thyroid arteries are risk factors for IITD development. IN CONCLUSION: Thyroid disorders are common during IFN-α therapy. Previous epidemiological data seem to be underestimated. Important risk factors for IITD development are: female sex, elevated serum TSH concentration (≥2.5 µU/mL), positive TPO-Ab and increased blood velocity in thyroid arteries.

Autoimmune hepatitis in the material of Department and Regional Hospital of Infectious Diseases in Gdansk.

BACKGROUND: The aim of the study was the analysis of patients with autoimmune hepatitis (AIH), with respect to diagnostics, clinical course and treatment, based on the material from the wards of infectious diseases. MATERIAL/METHODS: The study was carried out in the group of 106 AIH patients--95 females aged 11-81 (mean age 46 years) and 11 males aged 8-73 (mean age 35 years). The diagnosis of AIH was based on international criteria, including biochemical test results, autoantibodies, and liver tissue morphology. Serological test excluded hepatitis of viral etiology. Diagnostic procedures included also blood cell count, biochemical parameters of liver function with protein fractions, immunoassays (immunoglobulins, autoantibodies), according to commonly used methods. Liver biopsies were performed in 93 patients. RESULTS: The clinical presentation mimicked acute viral hepatitis in 75% of cases, in the remaining 25% corresponded to chronic viral hepatitis. 26% had other coincident disorders of autoimmune etiology. In 84% the initial stage of the disease was characterized with moderately severe course, in 11%--severe, 7% of the patients died--half of them at the initial stage of the disease. The following morphological patterns of hepatic abnormalities were observed: hepatitis chronica agresiva, fibrosis periportalis, hepatitis chronica agresiva in cirrhosim vertens, cirrhosis hepatis activa, hepatitis chronica persistence, hepatitis granulomatosa. Over 40% of patients demonstrated relapses of the disease due to discontinuation of treatment after obtaining clinical and biochemical remission. 51 patients were treated with glucocorticosteroid monotherapy, the same number with glucocorticosteroids combined with azathioprine, 1 female patient underwent liver transplantation. In nearly 30% of patients, the diagnosis of AIH was established after a period of persistence of pathologic symptoms of over a year. CONCLUSIONS: Late diagnoses of AIH indicate insufficient knowledge of the disease among physicians. The methods of treatment used in AIH are not sufficiently effective. Discontinuation of treatment should be preceded in each case by overall assessment of the pathologic process, including biochemical parameters, autoantibody level and liver histopathology.