Journal Article

Prospective Follow-Up of Patients with Acute Hepatitis C Virus Infection in Brazil

Lia L. Lewis-Ximenez, Georg M. Lauer, Julian Schulze zur Wiesch, Paulo Sergio Fonseca de Sousa, Cleber F. Ginuino, Gláucia Paranhos-Baccala, Hanno Ulmer, Karl P. Pfeiffer, Georg Goebel, João Luiz Pereira, Jaqueline Mendes de Oliveira, Clara Fumiko Tachibana Yoshida, Elisabeth Lampe, Carlos Eduardo Velloso, Marcelo Alves Pinto, Henrique Sergio Coelho, Adilson José Almeida, Carlos Augusto Fernandes, Arthur Y. Kim and Alexander M. Strasak

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 9, pages 1222-1230
Published in print May 2010 | ISSN: 1058-4838
Published online May 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651599
Prospective Follow-Up of Patients with Acute Hepatitis C Virus Infection in Brazil

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Background. The natural outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. However, little is known about host and viral factors associated with a self-limiting or chronic evolution of HCV infection.

Methods. From 1 January 2001 through 31 December 2008, a consecutive series of 65 patients from Rio de Janeiro, Brazil, with a well-documented diagnosis of acute HCV infection, acquired via various routes, were enrolled in this study. Patients were prospectively followed up for a median of 40 months after the estimated date of HCV infection with serial measurements of serum alanine aminotransferase, HCV RNA, and anti-HCV antibodies. Spontaneous viral clearance (SVC) was defined as undetectable levels of HCV RNA in serum, in the absence of treatment, for 3 consecutive HCV polymerase chain reaction tests within the first 6 months of follow-up. Cox proportional hazards regression was used to identify host and viral predictors of SVC.

Results. The cumulative rate of SVC was 44.6% (95% confidence interval, 32.3%–57.5%). Compared with chronic HCV evolution, patients with self-limiting disease had significantly lower peak levels of anti-HCV antibodies (median, 109.0 vs 86.7 optical density-to-cutoff ratio [od/co]; P < .02), experienced disease symptoms more frequently (69.4% vs 100%; P < .001), and had lower viral load at first clinical presentation (median, 4.3 vs 0.0 log copies; P = .01). In multivariate analyses, low peak anti-HCV level (<93.5 od/co) was the only independent predictor for SVC; the hazard ratio compared with high anti-HCV levels (⩾93.5 od/co) was 2.62 (95% confidence interval, 1.11–6.19; P = .03).

Conclusion. Our data suggest that low levels of anti-HCV antibodies during the acute phase of HCV infection are independently related to spontaneous viral clearance.

Journal Article.  6589 words.  Illustrated.

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

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