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

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 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.

The Impact of Illicit Drug Use on Spontaneous Hepatitis C Clearance: Experience from a Large Cohort Population Study

“…The only correlate of CHCV infection reported by them was low HCV antibody values [46]. The insignificant results in this study may have been due to the small sample size.…”

Association of IL-10, IL-4, and IL-28B gene polymorphisms with spontaneous clearance of hepatitis C virus in a population from Rio de Janeiro

“…This cohort of patients with acute HCV infection was previously evaluated by clinical and laboratory parameters [31]. Patients with undetected HCV RNA in three consecutive tests within 12-months of follow-up were considered as having spontaneous viral clearance.…”

“…Patients with undetected HCV RNA in three consecutive tests within 12-months of follow-up were considered as having spontaneous viral clearance. Further details were described elsewhere [31]. The inclusion criteria for chronic hepatitis C patients were: detectable anti-HCV antibodies with detectable serum, HCV RNA for 6 months of follow up, and a liver biopsy with characteristics of chronic HCV infection.…”

Immediate vs. delayed treatment in patients with acute hepatitis C based on IL28B polymorphism: A model-based analysis

“…Fourthly, we assumed that only two parameters were associated with spontaneous viral clearance and were considered in the model (IL28B genotype and whether the patient was symptomatic or asymptomatic). Indeed, although Hofer et al suggested that repeated measurements of serum viral load are associated with spontaneous viral clearance [9], many other studies could not conclude that HCV RNA baseline levels or kinetics are a predictor of HCV clearance [34,40,41]. In addition, other authors show that HCV RNA levels fluctuate in the setting of acute HCV infection, which may limit prediction of viral clearance [38,42].…”