title: Spontaneous resolution of chronic hepatitis C virus infection after antiviral treatment and relapse.
abstract: Clearance of acute hepatitis C virus (HCV) infection is associated with strong and multi-specific cellular immune responses which are often weak in chronic hepatitis C. We here report a case of spontaneous and sustained resolution of chronic hepatitis C virus infection in the absence of apparent HCV-specific immunity. The patient received standard antiviral therapy for chronic HCV infection and was HCV-RNA negative at the end of treatment but relapsed between follow-up week 4 and 12. Surprisingly, from follow-up week 28 on, he persistently was HCV-RNA negative in serum, even when being tested with the highly sensitive TMA-assay (cut-off 5-10IU/ml). ALT levels were within the normal range throughout follow-up. Virus-specific CD4+ T cell responses were prospectively analysed during the relapse period and during spontaneous resolution by interferon-gamma ELISPOT assays. Importantly, no HCV-specific cellular immune responses were detectable at any time-point. The patient suffered from an acute respiratory tract infection before HCV clearance and serum IL-8 levels were significantly increased during this period. Thus, spontaneous resolution of hepatitis C after antiviral treatment and relapse may occur even in the absence of hepatitis flares and apparent HCV-specific immune responses in single cases. The role of heterologous infections for HCV clearance requires further investigation.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Carl Neuberg Street 1, 30623 Hannover, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
authors.forename: Jasmin
authors.initials: J
authors.lastname: Sarhaddar
authors.forename: Johannes
authors.initials: J
authors.lastname: Wiegand
authors.forename: Ralf
authors.initials: R
authors.lastname: Lichtinghagen
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.forename: Ayse
authors.initials: A
authors.lastname: Ciner
authors.forename: Johannes
authors.initials: J
authors.lastname: Hadem
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.forename: Michael Peter
authors.initials: MP
authors.lastname: Manns
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer