In this issue Lenzi et al (see page435) provide convincing evidence that non-organ specific autoantibodies (NOSA) are highly prevalent in subjects exposed to hepatitis C virus (HCV), and their presence is associated with clinical and biochemical signs of liver disease. The observation that autoimmunity and HCV infection are associated is not new: several hundred hits are returned when Medline is interrogated using HCV and autoimmune, including autoantibodies, as coordinates. Invariably, however, the infected individuals are patients referred to hospital and who have undergone some form of selection, primarily dictated by the severity of their underlying disease. The population studied by Lenziet al makes their paper unique.

During the screening of an unselected population of 7000 (the Dionysos study1) for indicators of liver disease, 226 were positive for HCV markers. Lenzi and colleagues found NOSA in 25% of these subjects, a prevalence much higher than that of the 226 demographically matched uninfected individuals and of the 78 HBsAg positive subjects from the Dionysos study. Within the HCV positive group, the presence of NOSA was significantly associated with clinical and biochemical …