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Review of serologic testing for hepatitis C virus infection and risk of posttransfusion hepatitis C
1Hepatitis Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Insights
Hepatitis C virus (HCV) infection often leads to chronic liver disease. The virus appears to evade the immune system, hindering the development of effective vaccines or treatments.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis C virus (HCV) is a significant global cause of liver disease, including hepatitis and cirrhosis.
- Screening blood donors for HCV antibodies has decreased posttransfusion hepatitis C rates.
- Most acute HCV infections progress to chronic states, with a high percentage developing liver disease.
Purpose of the Study:
- To investigate the high rate of persistent HCV infection.
- To examine the effectiveness of the host's antibody response against HCV.
- To assess the implications for developing immunoprophylaxis.
Main Methods:
- Analysis of HCV infection rates in blood donors and recipients.
- Evaluation of chronic infection and liver enzyme levels.
- Review of experimental studies on HCV rechallenge in chimpanzees.
Main Results:
- Over 70% of anti-HCV positive donors are HCV RNA positive, but less than half show liver enzyme abnormalities.
- HCV infection demonstrates extreme persistence in humans.
- Chimpanzee studies show no protection against homologous HCV re-exposure.
Conclusions:
- HCV infection is highly persistent due to a failure to elicit an effective neutralizing antibody response.
- This immune evasion poses significant challenges for developing passive or active immunotherapies against hepatitis C.
Abstract:
Hepatitis C virus (HCV) is a major cause of acute and chronic hepatitis and cirrhosis worldwide. Screening volunteer donors for antibody to HCV (anti-HCV) has reduced the risk of posttransfusion hepatitis C to less than 1.0% per recipient. Virtually all persons with acute HCV infection seem to become chronically infected, and an average of 67% acquire chronic liver disease with persistently elevated liver enzyme values. Among anti-HCV-positive blood donors, 70% to 90% are HCV RNA positive, but less than half have biochemical evidence of liver disease. The extraordinarily high rate of persistent infection observed in humans and the lack of protection against rechallenge with homologous HCV strains demonstrated in experimental studies in chimpanzees suggest that HCV fails to induce an effective neutralizing antibody response. This raises major concerns for the development of effective passive or active immunoprophylaxis against hepatitis C.