Fluctuation patterns of HCV-RNA serum level in patients with chronic hepatitis C

Abstract

The serum level of hepatitis C virus (HCV)-RNA is clinically important as a predictor of the response to interferon (IFN) therapy in patients with chronic hepatitis C. If serum HCV-RNA levels fluctuate during follow-up, and IFN therapy is begun at the time of a low HCV-RNA level, the IFN therapy may be more effective. We evaluated the fluctuation of HCV-RNA serum levels for 2 years in 212 patients with chronic hepatitis C, untreated with IFN who had HCV genotype 1b and an HCV-RNA level of 10 Meq/ml or more at first consultation. The HCV-RNA level was measured monthly for 2 years with an HCV branched DNA probe assay (b DNA probe assay). We classified HCV-RNA patterns into three types by the ratio of maximum HCV-RNA level (a) to minimum HCV-RNA level (b). In pattern 1 (constant type, 151 patients; 71.2%) the a/ b ratio was 1-5. In pattern 2 (slight fluctuation type, 46 patients; 21.7%) the a/b ratio was 5-10. In pattern 3 (severe fluctuation type, 15 patients; 7.1%), the a/b ratio was 10 or more. Next, we evaluated the factors associated with the three patterns. Acute exacerbation of chronic hepatitis was regarded as an increase in serum alanine aminotransferase (ALT) level to more than 250 IU/l. The incidence of acute exacerbation for a 2-year follow-up was 13.9% (21/151) in pattern 1, 19.6% (9/46) in pattern 2, and 53.3% (8/15) in pattern 3. Multivariate analysis showed that acute exacerbation was the most important factor in the manifestation pattern 3. In conclusion, we found that: (1) about 70% of patients had a constant HCV-RNA levels for 2 years. (2) A few patients had severe fluctuation of serum HCV-RNA level after acute exacerbation of chronic hepatitis.

Factors Affecting Serum Concentrations of Hepatitis C Virus (HCV) RNA in HCV Genotype 1-Infected Patients with Chronic Hepatitis

“…Imprecision may have been relatively high (due to the use of several testing laboratories, technologists, runs, and reagent lots), but the same well-characterized HCV RNA assay was used for all six trials. If these trials' HCV RNA testing yielded within-patient variability of approximately Ϯ0.5 log 10 IU/ml, as others have reported (1,9,12,18,22,34,39,44,49,63), such "noise" in single [HCV RNA] values would not have affected our analyses more they did than in earlier studies. (21).…”

“…We therefore analyzed the baseline characteristics of 2,472 HCV genotype 1-infected patients to identify correlations with gender, age, race, weight, body mass index (BMI), HCV acquisition mode, HCV subtype, alanine aminotransferase concentration, or histopathologic changes in the liver. After separation of the data according to four [HCV RNA] BL groups (<5.0, >5.0 to 5.6, >5.6 to 5.9, and >5.9 log 10 IU/ml), we determined that increasing The serum levels of hepatitis C virus (HCV) RNA represent the abundance of HCV production versus clearance and are usually stable in humans with untreated chronic hepatitis C (CHC) (1,9,12,18,22,34,39,44,49,63). Between individuals, however, these baseline HCV RNA concentrations ([HCV RNA] BL ) vary by 3 to 4 log 10 IU/ml and the factors that determine these differences are poorly understood.…”

“…The serum levels of hepatitis C virus (HCV) RNA represent the abundance of HCV production versus clearance and are usually stable in humans with untreated chronic hepatitis C (CHC) (1,9,12,18,22,34,39,44,49,63). Between individuals, however, these baseline HCV RNA concentrations ([HCV RNA] BL ) vary by 3 to 4 log 10 IU/ml and the factors that determine these differences are poorly understood.…”

Interferon Therapy for Hapatitis C Virus (HCV)-related Advanced Chronic Hepatitis after Treatment of Recurrent Hepatocellular Carcinoma: A Successful Case.

“…Arase et al pointed out that normalization, albeit transient, of serum ALTduring IFN therapy and a low viral titer were predictive factors in determining whether readministration of IFN is successful (7). Arase et al also reported that there were patients with HCV-related chronic hepatitis whoshowed fluctuations in HCV-RNA levels, and that administration of IFN to those patients during the period of a low viral titer often proved to be quite effective (8).…”

Comparison of Serial Hepatitis C Virus Detection in Samples Submitted through Serology for Reflex Confirmation versus Samples Directly Submitted for Quantitation

“…Prior studies analyzing reflex specimens (7,16,18) did not evaluate whether there are significant differences in the frequency of HCV RNA detection or in the HCV viral load compared to those in specimens treated more optimally from the time of collection (5,13). In addition, the viral load is known to fluctuate over time (2,8,10,12,17).…”