Primary biliary cirrhosis (PBQ is generally considered to be an autoimmune disease as it is characterized by the presence of antimitochondrial antibodies (AMA) and autoreactive T cells1. Tissue-damaging autoreactivity is a rarity requiring a complex series of events to occur. The favoured hypothesis for the aetiology of PBC is that environmental factors trigger the disease is genetically susceptible individuals. This theory is supported by epidemiological evidence of geographic patterns in the prevalence of disease with the existence of clusters, as well as discordance among monozygotic twins. The possibility that the environmental factor(s) involved in the multi-step process of breakdown in self-tolerance are infectious agents has been generated by a number of studies, but even the best evidence is only circumstantial.
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