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Abstract
Introduction Serum Immunoglobulins (Igs) are commonly raised in Chronic Hepatitis C (HCV) but their clinical significance is not fully known. There is also little information on the normalisation of Igs post HCV treatment. We aimed to assess (1) the incidence of raised Igs in HCV patients, (2) the association between the most commonly raised Ig [Immunoglobulin (IgG)] and genotype [G] and liver fibrosis and (3) the association between normalisation of IgG in those achieving sustained viral response (SVR).
Methods Demographics, genotype, pre-and post-treatment Igs, Ishak liver fibrosis scores (F) and SVR of all patients undergoing treatment for HCV since 2006 was collected. Data from G2, G4, G6 and unknown genotype patients were not included in the analyses.
Results 295 (n) patients were treated in the study period {Genotype 1 [G1] 71, Genotype 3 [G3] 205, males 181 (mean age 45.4); females 114 (mean age 41.3)}.
217/295 (73%) patients had raised pre-treatment Igs-either alone or in combination. Raised pre-treatment IgG, IgM and IgA were seen in 32%, 22% and 11% of G1 and in 56%, 16% and 8% of G3 patients respectively. A significant association between viral genotype and raised pre-treatment level was seen only with IgG (p=0.0009) and not with IgA (p=0.46) or IgM (p=0.20).
In G1, 43% of patients with advanced fibrosis (F>4) had raised pre-treatment IgG compared to 29% of patients with F≤4 [non-significant (NS) association, p=0.66]. However in G3 advanced fibrosis (F>4) was significantly associated with raised pre-treatment IgG [33/41 (80%) with F>4 vs 70/130 (54%) with F≤4, p=0.0031] suggesting that pre-treatment IgG can be a good predictor of advanced fibrosis in G3.
Overall SVR was achieved in 34% in G1 and 65% in G3. In those who achieved SVR, normalisation of raised IgG was seen more in G3 than in G1 [52% vs 44%, NS association, p=0.72].
Conclusion Our study confirms: (1) Presence of raised serum immunoglobulins, particularly that of IgG is common in both G1 and G3 patients. (2) Significant association between raised pre-treatment IgG and advanced fibrosis is seen in G3 but not in G1. In G3, pre-treatment IgG level can be good predictor of advanced fibrosis. (3) Post-SVR normalisation of IgG is seen more in G3 than in G1.
Competing interests None declared.