Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection.
The purpose of this investigation was to prospectively characterize acute hepatitis C virus (HCV) infections and to evaluate the hypothesis that the outcome is affected by identifiable clinical or viral factors. One hundred forty-two people with a history of illicit drug use who were HCV antibody-negative in 1988 were followed semiannually through 1996. HCV seroconversion (second generation enzyme immunoassay and recombinant immunoblot assay) was recognized in 43 (30%) of the participants, who were followed up for a median of 72 months. HCV RNA was detected and quantified by polymerase chain reaction in a median of 10 specimens per participant and showed two distinct patterns of viremia: viral clearance was noted in 6 (14%) of the participants, and viral persistence was observed in 37 (86%) of the participants. Subjects with viral clearance were more likely to be white (P =.004), have jaundice (P =.03), and have lower peak viral titer (P =.003). However, the outcome for a given person could not be predicted by clinical features, RNA level, or HCV subtype (as ascertained by analysis of core-E1 complementary DNA sequence). No acute infections were recognized by health care providers. At the time of seroconversion, HCV RNA was detectable in 81% of participants, and recombinant immunoblot assay (RIBA) was positive in 85% of participants. We conclude that approximately 85% of people with acute hepatitis C develop persistent viremia. However, acute infections are uncommonly recognized clinically, underscoring the importance of screening individuals at risk. Long-term follow-up, but no single laboratory test, is necessary to ascertain the outcome and in some cases make the diagnosis of acute HCV infection.
Villano
S A
SA
Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Vlahov
D
D
Nelson
K E
KE
Cohn
S
S
Thomas
D L
DL
D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D018937:Hepatitis C Antibodies / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000235:genetics / Q000276:immunology / Q000821:virology*; D006801:Humans; D015151:Immunoblotting; D007565:Jaundice / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D014766:Viremia / Q000150:complications / Q000235:genetics / Q000276:immunology / Q000821:virology*
D018937:Hepatitis C Antibodies; D012367:RNA, Viral