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1999 Resident Poster Competition

W. Travis Dierenfeldt M.D.
Univ. of Missouri--Kansas City
Clinical and Histologic Significance of Positive Anti-Smooth Muscle Antibody (ASMA) in Patients Chronically Infected With Hepatitis C Virus (HCV)

Second Place
Research Division

W. Travis Dierenfeldt M.D.: Clinical and Histologic Significance of Positive Anti-Smooth Muscle Antibody (ASMA) in Patients Chronically Infected With Hepatitis C Virus (HCV)

Positive ASMA may occur in patients with chronic HCV and may indicate concomitant autoimmune liver disease. We anecdotally noted abnormal ASMA studies in a high percentage of our patients with chronic HCV who had no clinical or histologic evidence of autoimmune liver disease.

Methods: Patients who have HCV and a positive ASMA were compared retrospectively to patients with HCV and a negative ASMA. Baseline characteristics including HCV genotypes, initial viral load by RT-PCR, response rate to interferon therapy, histologic grade of disease activity and stage of fibrosis using the Knodell HAI were compared.

Results: Ninety-two consecutive patients with HCV were evaluated. Eighty-one patients were tested for ASMA and 30/81 patients (37%) had a positive ASMA. The ASMA titre was ‹1:160 in all but one patient. HCV genotypes 1,2,3 and 4 represented 63%, 20%,17% and 0% of ASMA positive patients and 71%,20%,6%, and 3% of ASMA negative patients (p=ns). The median viral load was 2.9 x 10 in patients with positive ASMA compared to 3.1 x 10 with a negative ASMA (p=ns). Review of 62 available liver biopsies showed no significant difference in the grade of disease activity (p-0.46) or the stage of fibrosis (p=0.59). Of the 51 patients who have completed monotherapy with alpha-interferon (INTRON A(r)) only 1/15 (7%) who were positive for ASMA responded to interferon compared to 6/36 patients (17%) who had a statistical significance (p+0.57). Discontinuation of therapy due to adverse events was similar in both groups.

Conclusion: A low titre of ASMA is common in patients chronically infected with HCV, but does not adversely affect the histologic factors or treatment outcome in patients with HCV.

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