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Natural history of acute symptomatic hepatitis type C

M Wawrzynowicz-Syczewska1, J Kubicka, Z Lewandowski

  • 1Dept. of Infectious Diseases, Pomeranian Medical University, Arkońska 4 str., PL-71-455 Szczecin, Poland, annabk@inet.com.pl

Infection
|June 10, 2004
PubMed

Insights

Nearly 30% of acute hepatitis C patients achieved spontaneous viral clearance, but testing peripheral blood mononuclear cells (PBMC) for HCV-RNA is crucial. Longer observation times increase the chance of viral clearance and seroreversion in hepatitis C virus (HCV) infection.

Area of Science:

  • Hepatology
  • Virology
  • Immunology

Background:

  • Investigated spontaneous clearance of hepatitis C virus (HCV) after acute infection.
  • Examined the progression of chronic HCV infection in non-cleared cases.

Purpose of the Study:

  • To identify factors influencing spontaneous viral clearance in acute hepatitis C.
  • To analyze factors associated with progressive liver disease in chronic hepatitis C.

Main Methods:

  • Recruited patients hospitalized for acute C or non-A, non-B hepatitis (1988-1998) for 2001 evaluation.
  • Tested for anti-HCV, serum HCV-RNA, PBMC HCV-RNA, and liver enzymes; liver biopsy for chronic cases.
  • Compared outcomes between HCV-RNA positive and negative subjects to determine clearance predictors.

Main Results:

  • Of 159 acute HCV patients, 77 (48.4%) were followed for a median of 8 years; 29.9% achieved spontaneous serum HCV clearance.
  • HCV-RNA detected in PBMC in two cases of apparent serum clearance; only three patients cleared anti-HCV.
  • Factors influencing clearance included acute infection severity and alcohol abuse; older age predicted clearance in non-alcoholic patients.
  • In chronic HCV, 40% had advanced fibrosis, linked to older age at infection, male gender, alcohol abuse, and higher iron content.

Conclusions:

  • HCV-RNA testing in peripheral blood mononuclear cells (PBMC) is essential for accurately assessing HCV infection resolution.
  • The possibility of a healthy carrier state for HCV warrants discussion.
  • Extended observation periods enhance the likelihood of seroreversion.
  • Advanced fibrosis in chronic hepatitis C may not solely result from inflammatory activity.
Abstract

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