Possible link between human papillomavirus and autoimmune hepatitis

In the last years numerous reports describing a possible association between administration of vaccines and development of autoimmune phenomena and overt autoimmune disease were published.

In a recent report the case of an 11-year-old girl who developed autoimmune hepatitis type II after four weeks from vaccination against human papillomavirus, is being researched. The possible relationships between the use of adjuvated vaccine against papillomavirus and autoimmune hepatitis are discussed. Although the report does not provide evidence for a causal link, they suggest that the occurrence of the autoimmune hepatitis may be related to the stimulation of immune system by adjuvated-vaccine, that could have triggered the disease in a genetically predisposed individual.

The CDC states that, “Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.”

Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible.

There are two types of autoimmune hepatitis: Type I and Type II. Type I accounts for most cases in North America; can occur at any age, and is most common in women. Approximately 50% of those diagnosed with type I autoimmune hepatitis also have other immune disorders, including type 1 diabetes, thyroiditis, Graves disease, ulcerative colitis, Sjogrenae’s syndrome, or autoimmune anemia. Type II is less common, and is seen mostly in young girls, ages 2-14 in Southern Europe, although adults can be diagnosed with it as well.

Symptoms of autoimmune hepatitis include fatigue, jaundice, itching, an enlarged liver, skin rashes, joint pain, abdominal discomfort, nausea, vomiting, lack of appetite, dark urine, pale-colored stools, and spider veins on the skin. Patients with advanced disease are more likely to have ascites (fluid in the abdomen) or encephalopathy (mental confusion), which result from chronic liver dysfunction. Women with the condition may stop having menstrual periods.

Early treatment of autoimmune hepatitis is vital to control disease progression, prevent, and even reverse some liver damage. Treating this condition involves suppressing the patient’s overactive immune system. This is accomplished by treating (both types of) autoimmune hepatitis with the lowest dose of prednisone that is effective.

Close monitoring of liver function test following administration of the vaccine against papillomavirus may be useful in adolescent girls with signs of hepatopathy, as jaundice, dark urine or hepatomegaly, to early identify and to promptly treat autoimmune liver disorders.


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