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Prospective follow-up of patients with acute hepatitis C virus infection in Brazil

  • Authors: Lewis- Ximenez LL, Lauer GM, Schulze Zur Wiesch J, de Sousa PS, Ginuino CF, Paranhos-Baccalà G, Ulmer H, PfeIF 2010fer KP, Goebel G, Pereira JL, Mendes de Oliveira J, Yoshida CF, Lampe E, Velloso CE, Alves Pinto M, Coelho HS, Almeida AJ, Fernandes CA, Kim AY, Strasak AM

  • Journal: Clin Infect Dis. 2010 May 1;50(9):1222-30

  • Type: Article

  • Directorate: Scientific Directorate

  • Published: 2010

Abstract

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>

or =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.

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