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Lower risk of multiple sclerosis in patients with chronic hepatitis C: a nationwide population-based registry study

Journal article
Authors J. Soderholm
Aylin Yilmaz
A. Svenningsson
K. Busch
Rune Wejstål
A. Brolund
J. Kovamees
M. Sallberg
Martin Lagging
Magnus Gisslén
Published in Journal of Neurology
Volume 266
Issue 9
Pages 2208-2215
ISSN 0340-5354
Publication year 2019
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 2208-2215
Language en
Links dx.doi.org/10.1007/s00415-019-09397...
Keywords Hepatitis C, Multiple sclerosis, Registries, class-ii alleles, genetic-variation, b-cells, virus, antibodies, prevalence, clearance, infection, il28b, hiv, Neurosciences & Neurology
Subject categories Neurology, Infectious Medicine

Abstract

Background Multiple sclerosis (MS) is an immune-mediated neurological disease that causes demyelination. The etiology is unknown, but patients with a previous viral infection, such as Epstein-Barr virus, have been shown to be at a higher risk of developing MS. In contrast, people living with HIV have a lower risk of developing MS. Hepatitis C virus (HCV) mainly infects the liver, but patients with HCV can experience several extrahepatic manifestations and studies have shown an association with several autoimmune conditions such as neuropathy and myelitis. The present study aimed to investigate the risk of MS in patients with chronic HCV infection compared with matched comparators. Methods Patients were identified using the nationwide Swedish inpatient (2001-2013) and outpatient care registers (2001-2013) for HCV (B18.2) and MS (G35) according to the International Classification of Diseases-10. Up to five comparators (matched on age/sex/place of residency) were drawn from the general population for each HCV patient. Follow-up started at the first HCV visit from 2001 and the patients' accrued person-time until death, emigration or 31 December 2013. Risk of MS diagnosis was calculated as standardized incidence ratio (SIR) with 95% confidence intervals (CIs). Results HCV patients were at lower risk of MS diagnosis (SIR 0.37; 95% CI 0.26-0.50). The incidence of MS during the study in the HCV cohort was 0.087% compared with 0.27% in the matched comparator cohort. Conclusion Surprisingly, these data suggest HCV patients to have a lower risk of MS diagnosis.

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