Anti‐cardiolipin antibodies in patients with chronic viral hepatitis are independent of beta2‐glycoprotein I cofactor or features of antiphospholipid syndrome

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Abstract
Background Although controversial, some authorities have implicated hepatitis C virus (HCV) as a cause of anti‐phospholipid syndrome (APLS). Anti‐cardiolipin antibodies (anti‐CLAbs) in APLS are cofactor‐dependent (‘pathogenic’ antibodies). We conducted a study in order to determine the prevalence of anti‐CLAbs in HCV patients, and furthermore to address whether these autoantibodies are cofactor‐dependent or not and whether they are associated with features of APLS. Patients with hepatitis B virus (HBV) were also evaluated in order to assess whether there are differences in the prevalence and the clinical significance of anti‐CLAbs between these two major types of chronic viral hepatitis. Materials and methods One hundred and seventy‐four consecutive HCV patients, 50 HBV patients and 267 healthy were investigated for the presence of anti‐CLAbs and antibodies against beta2‐glycoprotein I (β2‐GPI), which is the most important cofactor of the ‘pathogenic’ anti‐CLAbs in APLS. IgG anti‐CLAbs were determined by an in‐house quantitative ELISA and anti‐β2‐GPIAbs using a commercial ELISA kit. Results 21·3% of the HCV and 14% of the HBV patients tested positive for IgG anti‐CLAbs (P < 0·0001 compared with healthy controls). Neither age, sex, certain epidemiologic and laboratory parameters nor the clinical status and the histologic findings were associated with anti‐CLAbs detection in both diseases. 2·3% of the HCV (P < 0·05 compared with healthy controls) and 2% of the HBV patients tested positive for anti‐β2‐GPIAbs. Presence of anti‐CLAbs was not associated with features of APLS. Conclusions A significant proportion of the HCV and HBV patients had detectable IgG anti‐CLAbs. However, the anti‐CLAbs titres were relatively low, and in most cases seem to be cofactor‐independent (‘nonpathogenic’). The latter is further supported by the lack of their association with clinical features of APLS. Furthermore, anti‐CLAbs appear to be detected irrespective of the demographic, laboratory, clinical and histologic status in both HCV and HBV. However, prospective studies of longer duration may be required in order to address whether anti‐CLAbs in patients with chronic viral hepatitis are or are not of clinical importance.