TY - JOUR
T1 - Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection
AU - Villano, Stephen A.
AU - Vlahov, David
AU - Nelson, Kenrad E.
AU - Cohn, Sylvia
AU - Thomas, David L.
PY - 1999
Y1 - 1999
N2 - 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 vital 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.
AB - 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 vital 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.
UR - http://www.scopus.com/inward/record.url?scp=0033023854&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033023854&partnerID=8YFLogxK
U2 - 10.1002/hep.510290311
DO - 10.1002/hep.510290311
M3 - Article
C2 - 10051497
AN - SCOPUS:0033023854
SN - 0270-9139
VL - 29
SP - 908
EP - 914
JO - Hepatology
JF - Hepatology
IS - 3
ER -