Prospective follow-up of patients with acute hepatitis C virus infection in Brazil.
BACKGROUND
The natural outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. However, little is known about host and viral factors associated with a self-limiting or chronic evolution of HCV infection.


METHODS
From 1 January 2001 through 31 December 2008, a consecutive series of 65 patients from Rio de Janeiro, Brazil, with a well-documented diagnosis of acute HCV infection, acquired via various routes, were enrolled in this study. Patients were prospectively followed up for a median of 40 months after the estimated date of HCV infection with serial measurements of serum alanine aminotransferase, HCV RNA, and anti-HCV antibodies. Spontaneous viral clearance (SVC) was defined as undetectable levels of HCV RNA in serum, in the absence of treatment, for 3 consecutive HCV polymerase chain reaction tests within the first 6 months of follow-up. Cox proportional hazards regression was used to identify host and viral predictors of SVC.


RESULTS
The cumulative rate of SVC was 44.6% (95% confidence interval, 32.3%-57.5%). Compared with chronic HCV evolution, patients with self-limiting disease had significantly lower peak levels of anti-HCV antibodies (median, 109.0 vs 86.7 optical density-to-cutoff ratio [od/co]; P<.02), experienced disease symptoms more frequently (69.4% vs 100%; P<.001), and had lower viral load at first clinical presentation (median, 4.3 vs 0.0 log copies; P=.01). In multivariate analyses, low peak anti-HCV level (<93.5 od/co) was the only independent predictor for SVC; the hazard ratio compared with high anti-HCV levels (> or =93.5 od/co) was 2.62 (95% confidence interval, 1.11-6.19; P=.03).


CONCLUSIONS
Our data suggest that low levels of anti-HCV antibodies during the acute phase of HCV infection are independently related to spontaneous viral clearance.
Lewis-Ximenez
Lia L
LL
Viral Hepatitis Laboratory, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil. lialewis.fiocruz@gmail.com
Lauer
Georg M
GM
Schulze Zur Wiesch
Julian
J
de Sousa
Paulo Sergio Fonseca
PS
Ginuino
Cleber F
CF
Paranhos-Baccalá
Gláucia
G
Ulmer
Hanno
H
Pfeiffer
Karl P
KP
Goebel
Georg
G
Pereira
João Luiz
JL
Mendes de Oliveira
Jaqueline
J
Yoshida
Clara Fumiko Tachibana
CF
Lampe
Elisabeth
E
Velloso
Carlos Eduardo
CE
Alves Pinto
Marcelo
M
Coelho
Henrique Sergio
HS
Almeida
Adilson José
AJ
Fernandes
Carlos Augusto
CA
Kim
Arthur Y
AY
Strasak
Alexander M
AM
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001938:Brazil; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D055815:Young Adult
D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase