Protracted, But Not Acute, Hepatitis A Virus Infection Is Strongly Associated With Hla–Drb1*1301, A Marker for Pediatric Autoimmune Hepatitis
2001; Lippincott Williams & Wilkins; Volume: 33; Issue: 6 Linguagem: Inglês
10.1053/jhep.2001.24562
ISSN1527-3350
AutoresLeonardo Fainboim, M Velasco, C.Y. Marcos, Mirta Ciocca, Adriana Roy, Graciela Theiler, M. Capucchio, Silvia Nuncifora, Livio Sala, Marta Zelazko,
Tópico(s)Systemic Lupus Erythematosus Research
ResumoHLA alleles are known to be associated with susceptibility to develop autoimmune hepatitis (AH), and hepatitis A virus (HAV) infection is postulated as a putative trigger for AH. We investigated whether HLA may influence the outcome of the HAV infection by studying 67 children with self-limited and 39 children with protracted forms of this infection. HLA typing of the uncomplicated forms showed no significant increase of any HLA class I or II alleles. In contrast, DRB1*1301 was present in 46.1% of the children with protracted forms (vs. 9.8% in healthy controls; relative risk [RR]: 7.6; chi(2) = 33.3; P = 2 x 10(-9)). In uncomplicated hepatitis, 45% developed anti-smooth muscle antibody (SMA)/actin antibodies, but only 1 child had detectable antibodies after 3 months of infection onset. In contrast, after 1 year, 69% of the patients suffering protracted forms had titers of anti-SMA/actin antibodies that ranged between 1:40 and 1:160. Within their follow-up, 2 patients developed a Hashimoto's thyroiditis, but the remaining patients showed no signs of developing autoimmune hepatitis. We conclude that the DRB1*1301 haplotype is strongly associated with the protracted forms of HAV infection and suggest that the infection allows a sustained release of liver self-antigens. However, other still-unknown susceptibility genes are required for the full development of pediatric AH.
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