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Occult infection with hepatitis C virus: friend or foe?
Peter B Sugden1, Barbara Cameron, Rowena Bull
1Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Hepatitis C virus (HCV) infection can lead to chronic disease, but some clear it. A new
Area of Science:
- Virology
- Immunology
- Hepatology
Background:
- Hepatitis C virus (HCV) infection is a significant global health concern, causing cirrhosis and mortality.
- Transmission primarily occurs through blood-to-blood contact.
- Most infected individuals develop chronic infection, while a few clear the virus naturally.
Purpose of the Study:
- To review the literature on "occult" Hepatitis C virus (HCV) infection.
- To explore the potential extra-hepatic reservoirs of HCV.
- To investigate the clinical significance and host benefits of occult HCV infection.
Main Methods:
- Literature review of published studies on occult HCV infection.
- Analysis of viral RNA detection methods (commercial vs. ultra-sensitive assays).
- Examination of potential viral reservoirs in peripheral blood mononuclear cells.
Main Results:
- Occult HCV infection is characterized by undetectable serum viral RNA via standard assays but detectable via ultra-sensitive methods.
- Evidence suggests peripheral blood mononuclear cells may serve as an extra-hepatic reservoir for HCV.
- The clinical significance of occult infection, including potential for recrudescence, is still under investigation.
Conclusions:
- Occult HCV infection represents a potential third outcome following primary infection.
- Further research is needed to understand the clinical implications and host-pathogen interactions in occult infection.
- Occult infection might play a beneficial role in maintaining host immunological memory against HCV reinfection.
Abstract:
Hepatitis C virus (HCV) infection is a global pandemic associated with a growing disease burden due to cirrhosis and the consequent morbidity and mortality. Transmission is largely via blood-to-blood contact. Following primary infection, a minority of individuals clear the infection predominantly via cellular immune mechanisms, whereas the majority become chronically infected. Recent data suggest that a third outcome may also be possible, termed 'occult' infection in which subjects who are known, or suspected to have previously been infected with HCV, no longer have viral RNA in their serum at levels detectable by sensitive commercial assays, but do have virus detected by ultra-sensitive techniques. Occult infection has also been detected in peripheral blood mononuclear cells, which may indicate an extra-hepatic reservoir of the virus. Although the clinical significance of occult infection remains unknown, most authors have raised concerns of recrudescent infection. Here we critically review the published literature, suggest further avenues of investigation and propose that occult infection may be beneficial to the host by maintaining immunological memory to protect against reinfection.
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