CD40LG and hepatitis A virus infection: Also, several authors have suggested that the progressive HCV infection may increase the frequency of anti-cardiolipin antibodies (ACA) and that it may lead to an increase in cell surface phospholipids and pro-inflammatory cytokines responsible for the production of ACA, thus resulting in endothelial and liver damage.16 Sahan et al.17 used liver biopsy to assess the hepatitis activity index in a total of 25 subjects with chronic hepatitis C infection and measured anti-cardiolipin antibody immunoglobulin M (ACA IgM).