Journal Article

Improving the Diagnosis of Acute Hepatitis C Virus Infection with Expanded Viral Load Criteria

Barbara H. McGovern, Christopher E. Birch, Melinda J. Bowen, Laura L. Reyor, Ellen H. Nagami, Raymond T. Chung and Arthur Y. Kim

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 7, pages 1051-1060
Published in print October 2009 | ISSN: 1058-4838
Published online October 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/605561
Improving the Diagnosis of Acute Hepatitis C Virus Infection with Expanded Viral Load Criteria

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Background.The diagnosis of acute hepatitis C virus (HCV) infection is imprecise because antibody testing does not differentiate between acute and chronic infection. Although virologic features, such as viral load fluctuations and low levels of viremia, have been noted to be characteristic of acute HCV infection, these parameters have not been used for diagnosis.

Methods.We validated the use of these novel parameters (ie, viral load fluctuations >1 log and HCV RNA levels <100,000 IU/mL) in a cohort of acute HCV seroconverters. We then applied standard diagnostic criteria for acute HCV infection in a cohort of high-risk injection drug users entering prison with suspected acute HCV infection (n=37). We subsequently assessed whether these novel virologic parameters, measured serially over a 10-week period, could enhance the diagnosis of acute infection.

Results.Low-level viremia and viral load fluctuations were highly prevalent in our cohort of acute seroconverters (81% and 86%, respectively), whereas low-level viremia occurred in only 13% of control patients with chronic infection. With use of standard criteria, 37 inmates received a diagnosis of acute HCV infection. Among the 35 patients with HCV RNA detectable at baseline, we found low-level viremia to be highly prevalent (n=27; 77%); among patients with a minimum of 2 HCV RNA samples, we demonstrated viral fluctuations in more than one-third (n=9; 36%).

Conclusions.The diagnosis of acute infection in HCV-seropositive patients is strengthened by the use of virologic parameters that are uncommon in chronic disease. Viral load fluctuations and low levels of HCV RNA should be incorporated into standard diagnostic criteria.

Journal Article.  4758 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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