The HLA class II-restricted T-cell response to hepatitis C virus (HCV) antigens is believed to influence the final outcome of hepatitis C, because it is vigorous in patients who recover from acute hepatitis C, but it is weak in those who develop a chronic infection. For this reason, exogenous stimulation of T-cell responses in chronic HCV infection may represent a strategy to cure patients with chronic hepatitis C by approximating the vigor of their T-cell reactivity to that of patients who succeed in recovering from hepatitis. It may also be a preventive approach to avoid spread of the virus by facilitating the development of a vigorous protective response at the very early stages of infection. T-cell-based vaccines composed of immunodominant, promiscuous, and conserved T-cell epitopes may represent a powerful tool to achieve optimal stimulation of the T-cell reactivity. To identify HLA class II-restricted T-cell epitopes useful for this purpose, 22 subjects with acute HCV infection were studied and followed for an average time of 29 months. Eight of them recovered from hepatitis, and 14 developed a chronic infection. Overlapping 20-mer peptides covering the entire core and NS4 antigens and a panel of peptides representing highly conserved regions of core, NS3, NS4, and NS5 were used. By direct peripheral blood T-cell stimulation and by finespecificity analysis of HCV-specific T-cell lines and clones, highly immunogenic T-cell epitopes were identified within core, NS3, and NS4. All these epitopes are immunodominant and highly conserved among the known HCV isolates. Moreover, they are promiscuous, because they can be presented to T cells by different HLA class II molecules. Immunodominance, sequence conservation, and promiscuity make these epitopes ideal components of preventive or therapeutic T-cell-based vaccines against HCV. (HEPATOL-OGY 1999;30:1088-1098.)The hepatitis C virus (HCV) is a RNA virus that can cause either acute self-limited infections or, more frequently, chronic liver cell injury leading to cirrhosis and hepatocellular carcinoma in a high proportion of cases. 1 The mechanisms responsible for persistence or viral clearance are still largely unknown. However, recent studies reported different patterns of proliferative T-cell response and cytokine production by antigen-specific CD4 ϩ T cells in patients with self-limited or chronically evolving HCV infection. [2][3][4] Patients with selflimited acute hepatitis show more vigorous peripheral blood proliferative T-cell responses to HCV proteins, predominantly sustained by Th1-like lymphocytes able to secrete proinflammatory cytokines (interferon gamma [IFN-␥] and interleukin-2 [IL-2]). Patients with chronic evolution of infection display weaker and less efficient proliferative T-cell responses suggesting that the intensity of the T-cell reactivity at the early stages of infection may be critical to limit the spread of the virus within the infected host and to keep viral replication under control. 2,3 In continuation of our previous studies suggestin...