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Chronic HBV can lead to autoimmune hepatitis?
Sep 3, 2012

Hello Dr McGovern,

I have been a life-long carrier of Hepatitis B for 40 years. My doctor believes I am an inactive carrier because my liver function tests, ALT, AST have been consistently normal. (By normal, I mean ALT < 33 IU, not like the ridiculous ULN of 55 IU reported by some labs). Viral load has never exceeded 3000 IU. Even liver biopsy shows zero fibrosis and no significant inflammation. So I guess I am very likely to remain an inactive carrier without the need for any treatment.

One lab that concerns me is this: Anti-smooth muscle antibody: positive. Anti-smooth muscle antibody titer: 1:160

My understanding is that 1:40 is barely positive, 1:80 is suspicious, and 1:160 is very suggestive of auto-immune hepatitis. 1:320 basically leaves no doubt. As you can see, my titer is right at the edge.

Other markers of auto-immune disease are negative: ANA, F-actin antibodies, AMA.

I came across an article which proposes the idea that antibodies against part of HBV polymerases may cross-react with self-proteins.

Mimicry Between the Hepatitis B Virus DNA Polymerase and the Antigenic Targets of Nuclear and Smooth Muscle Antibodies in Chronic Hepatitis B Virus Infection.

This really scares me. Does my high level of anti-smooth muscle antibodies suggest that I will eventually get autoimmune hepatitis? Have you seen any HBV patients with auto-immune disease? If so, how are they treated?

Thanks, JK

Response from Dr. McGovern

I looked up the journal article you found, but you will note that this is only a studies of laboratory phenomena...There are no liver biopsy results reported. Autoimmune disease is a diagnosis based on liver histology in most cases.

Some patients with autoimmune hepatitis have other clues regarding their liver disease, such as thyroid problems, diabetes, anemia and platelet problems....

I would not jump to the conclusion that you have autoimmune hepatitis. Would speak to your physician further. By the way, you can see this positive in patients who are overweight.

HCV Transmission through nick with a washed trimmer.
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