Treatment of Chronic Viral Hepatitis in Patients with Autoimmune Diseases

There exists an intricate relationship between chronic viral hepatitis, its treatment, and autoimmunity. A vast array of extrahepatic manifestations is associated with hepatitis C (1) and, to a lesser extent, hepatitis B (2); many of these conditions are mediated through autoimmune mechanisms. Shortly after the release of interferon α-2b (IFN-α2b) for the treatment of these viral infections came reports of autoimmune disorders that were either caused or unmasked by the use of this agent. Because patients with known autoimmune diseases were routinely excluded from IFN treatment trials, literature regarding the use of this agent in this important patient group is scant. Anecdotal reports and a review of the available literature, however, provide valuable clinical information, and shed light on this intriguing, but poorly documented subject.