Author:
SANAA M. KAMAL, et al
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Date Posted: Tue, October 02 2001, 20:59:28 PDT
Acute Hepatitis C Without and With Schistosomiasis: Correlation With Hepatitis C-Specific CD4+ T-Cell and Cytokine Response
SANAA M. KAMAL,*,,§ JENS W. RASENACK,§ LEONARDO BIANCHI, AHMED AL TAWIL,¶ KHALIFA EL SAYED KHALIFA,# THOMAS PETER,§ HODA MANSOUR,** WAFAA EZZAT, and MARGARET KOZIEL*
*Department of Infectious Diseases, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Ain Shams, Cairo, Egypt; §Department of Internal Medicine II, Gastroenterology and Hepatology, University of Freiburg, Germany; Department of Pathology, University of Basel, Basel, Switzerland; Departments of ¶Pathology and #Parasitology, University of Ain Shams, Cairo, Egypt; **Abassia Fever Hospital, Cairo, Egypt; and Tanta Fever Hospital, Tanta, Egypt
Background & Aims: Immune responses during the first few months of acute hepatitis C virus (HCV) infection seem crucial for viral control, but the relationship of these responses to natural history is poorly characterized. Methods: This prospective study investigated the HCV-specific CD4+ and cytokine responses in patients with acute HCV hepatitis with or without Schistosoma mansoni coinfection, a parasitic infection with T helper (Th) 2 immune bias. HCV-specific CD4+ proliferative responses and cytokine production in peripheral blood mononuclear cells were correlated with liver biopsy results at 6 months and at the end of follow-up. Results: Whereas 5 of 15 patients with HCV alone recovered from acute HCV, all (17 of 17) patients with S. mansoni coinfection progressed to histologically proven chronic hepatitis. Coinfected patients had either absent or transient weak HCV-specific CD4+ responses with Th0/Th2 cytokine production. The magnitude of the HCV-specific CD4+ response at week 12 was inversely correlated with the fibrosis progression rate in chronically infected patients. Conclusions: Patients with acute hepatitis C and schistosomiasis coinfection cannot clear viremia and show rapid progression once chronic infection is established. This rapid progression is associated with a strong Th2 response in peripheral immune responses, suggesting that early development of vigorous Th1 responses not only facilitates clearance but delays disease progression.
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GASTROENTEROLOGY 2001;121:646-656
© 2001 by the American Gastroenterological Association
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