Immune-mediated liver damage in chronic hepatitis C

Although the exact mechanisms inducing the hepatic injury in chronic hepatitis C infection are still not completely elucidated, the evidence of a direct cytopathic viral effect is sparse. The overall majority of experimental studies and clinical observations among patients instead favour immune-mediated hepatocellular damage. This does not exclude the possibility of direct cytopathic viral effects partly contributing to the cell injury. The immune reaction is not always harmful, however. Instead, an intact immune system is probably important for virus clearance in acute infection and after interferon treatment. The therapeutic possibilities are still not adequate, and attempts to understand the immunologic events and manipulate them could perhaps in the future give us more effective tools in the management of this disease.