Viral infections and antiphospholipid antibodies*,**

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Abstract

Objective: To study the relationship between viral infections and the induction of antiphospholipid (aPL) antibodies. Methods: We reviewed the medical literature from 1968 until 2000 using MEDLINE and the key words virus, infection, antiphospholipid, and anticardiolipin. Results: Anticardiolipin antibodies and/or lupus anticoagulant were associated with a number of viral infections, including hepatitis C virus, human immunodeficiency virus, cytomegalovirus, varicella zoster, Epstein-Barr virus, adenovirus, and parvovirus B. In many instances, the presence of these antibodies was associated with thrombosis. Conclusion: The clinical significance of finding aPL antibodies in patients with viral infections remains unknown. In some patients, these antibodies may be transient and disappear within 2 or 3 months. In other susceptible individuals, they may persist and raise the question of whether infections may trigger the development of aPL antibodies in autoimmune diseases. Semin Arthritis Rheum 31:256-263. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Methods

We reviewed the medical literature from 1968 to 2000 using MEDLINE and the key words virus, infection, aPL, and aCL. The relevant publications for the following viral infections were evaluated and described in chronological order: hepatitis C virus (HCV), HIV, cytomegalovirus (CMV), varicella zoster, Epstein-Barr virus (EBV), adenovirus, and parvovirus B. Clinical features of APS associated with aCL antibodies in the different viral infections are summarized in Table 1.

Hepatitis C virus

Investigators have frequently reported aPL antibodies in patients with chronic HCV infection. In 1994, in the earliest report on this association, al-Saeed et al (16) tested the sera of 52 hemophiliacs and demonstrated that HCV infection is strongly associated with raised serum levels of aPL antibodies even in the absence of HIV infection. In a later study by Biron et al (17), 33% of 124 patients with chronic HCV infection had aPL antibodies. Prieto et al (18) studied aCL antibodies in the sera

Discussion

These observations may suggest that certain infections in genetically predisposed individuals may induce autoimmunity. This hypothesis is further supported by some recent experiments; we induced aPL and anti-β2-GPI antibodies with properties similar to autoimmune aPL antibodies in mice by immunization with PL-binding synthetic peptides derived from adenovirus, CMV, and bacillus subtilis (54). Some of these aPL antibodies induced by CMV peptides were shown to be pathogenic. They activated the

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    *

    Imad W. Uthman, MD, MPH: Associate Professor, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Azzudin E. Gharavi, MD: Professor of Medicine, Morehouse School of Medicine, Atlanta, GA.

    **

    Address reprints to Imad W. Uthman, MD, MPH, American University of Beirut Medical Center, PO Box 113-6044, Beirut, Lebanon. E-mail: [email protected]

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