Hepatitis C virus antibody positivity may not be associated with hepatitis C infection in patients with autoimmune gastritis

Autoimmune gastritis (AIG) is an organ-specific autoimmune and inflammatory condition that manifests itself by loss of gastric parietal cells. It is usually clinically silent in the early stages of the disease, and demonstrable by the formation of antibodies against parietal cells and/or intrinsic factor 1. Patients infected with hepatitis C virus (HCV) frequently have antibodies and various autoimmune diseases 2–4. The relationship between HCV and extrahepatic manifestations is well established 5. Our recent observation that some of the patients with AIG have HCV antibodies (anti-HCV) has led us to investigate the prevalence of anti-HCV positivity and associated factors in patients with AIG 6. We evaluated 104 patients with AIG by HCV serology and compared them with 108 patients who were referred for gastrointestinal endoscopy. Patients with existing liver disease, esophageal varices noted during endoscopy, a history of previous surgery, and blood transfusion were excluded from the study. Anti-HCV was measured by an enzyme-linked immunoassay (Abbott Laboratories, Chicago, Illinois, USA). Four of the patients with AIG were positive for anti-HCV; however, none of the individuals from the control group were positive for anti-HCV (4/104 vs. 0/108, P=0.04). Four patients who were anti-HCV positive were tested with HCV-RNA (Roche Diagnostics, Basel, Switzerland) and were found to be negative. The demographic and clinical characteristics of these four patients are shown in Table 1. All of these four patients were positive for antiparietal cell antibody (APCA); one of them had concurrent autoimmune thyroid disease. Logistic regression analysis showed that sex (P=0.055), age (P=0.360), APCA positivity (P=0.149), anti-Helicobacter IgG (P=0.906), and serum gastrin level (0.484) were not significant risk factors for anti-HCV positivity.Table 1: Demographic and clinical parameters of anti-hepatitis C virus positive patientsGastric autoimmune diseases have been analyzed extensively in 189 patients with chronic hepatitis C infection before, during, and after interferon-α therapy by Fabbri et al.7. They found APCA positivity and three-fold gastrin levels in three and nine patients at baseline, in 25 and 31 patients after interferon-α therapy, and in seven and 14 patients 12 months after withdrawal. They reported that the development of AIG was associated with the prevalence of autoimmune thyroiditis and concluded that interferon therapy was closely associated with the occurrence of AIG especially in female patients. Our study approached this issue from another point of view by investigating the existence of anti-HCV in patients with AIG. As AIG is an autoimmune disease, autoimmunity may play a role in the development of false-positive anti-HCV test results. Another explanation for the false-positive test results may be associated with the test used. Ali and Lal 8 investigated 254 anti-HCV-positive patients and they found viremia in 211 patients; the remaining 43 (16.9%) patients were false positive. In conclusion, physicians managing patients with AIG should keep in mind that anti-HCV positivity may exist in some of the patients with AIG and this condition is not always associated with HCV infection, considering patients’ fears and concerns about having a serious infection. Acknowledgements Conflicts of interest There are no conflicts of interest.

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