This study was performed to compare the vigor and phenotype of virus-specific CD4 ؉ and CD8 ؉ T-cell responses in patients with different virologic and clinical outcomes after hepatitis C virus (HCV) infection. The results show that a vigorous and multispecific CD4 ؉ proliferative T-cell response is maintained indefinitely after recovery from HCV infection whereas it is weak and focused in persistently infected patients. In contrast, the HCV-specific CD8 ؉ T-cell response was quantitatively low in both groups despite the use of sensitive direct ex vivo intracellular interferon gamma (IFN-␥) staining. Furthermore, although HCV-specific cytolytic CD8 ؉ memory T cells were undetectable ex vivo, they were readily expanded from the peripheral blood of chronically HCV-infected patients but not from recovered subjects after in vitro stimulation, suggesting that ongoing viremia is required to maintain the HCV-specific memory CD8 ؉ T-cell response. HCV-specific CD8 ؉ T cells displayed a type 1 cytokine profile characterized by production of IFN-␥ despite persistent HCV viremia. The paradoxical observation that HCV-specific CD4 ؉ T cells survive and CD8 ؉ T cells are lost after viral clearance while the opposite occurs when HCV persists suggests the existence of differential requirements for the maintenance of CD4 ؉ and CD8 ؉ T-cell memory during HCV infection. Furthermore, the relative rarity of circulating CD8 ؉ effector T cells in chronically infected patients may explain the chronic insidious nature of the liver inflammation and also why they fail to eliminate the virus. (HEPATOLOGY 2001;33:267-276.)Hepatitis C virus (HCV) is a parenterally transmitted hepatotropic RNA virus that causes acute and chronic hepatitis. 1,2 While acute infection is generally subclinical, and therefore difficult to identify, chronic infection occurs in the majority of cases, and this can be associated with chronic hepatitis, cirrhosis, and hepatocellular carcinoma. 3,4 The role of CD4 ϩ and CD8 ϩ T cells in HCV clearance or disease pathogenesis is not well understood. Certainly, persistent infection occurs despite the presence of virus-specific CD4 ϩ and CD8 ϩ T cells in the liver and the peripheral blood, suggesting that these responses are ineffective in most patients. [5][6][7][8][9][10][11][12] The CD8 ϩ T-cell response to HCV may be only partially successful in virus control because it is quantitatively inadequate, [13][14][15][16][17] and it may also select for immune escape variants that further contribute to viral persistence. 13,[18][19][20] The role of CD8 ϩ T cells in this infection is most clearly illustrated, perhaps, in experimentally infected chimpanzees where a multispecific intrahepatic HCV-specific CD8 ϩ T-cell response during the early phase of infection was associated with subsequent HCV clearance while a more narrowly focused and delayed response was associated with persistent infection. 21 In contrast to these results, however, the relationship between the HCV-specific CD8 ϩ T-cell response and the outcome of infection...