Spontaneous Clearance of Chronic HCV: The Key Ending Left in the Dark

Abstract

BACKGROUND: Hepatitis C is the second leading cause of liver cirrhosis and hepatocellular carcinoma. Although the discovery of direct-acting agents made the disease curable, HCV elimination can be achieved solely by the host’s immunologic arsenal.
 CASE REPORT: We report the case of a 29-year-old woman with chronic hepatitis C infection - elevated transaminases, positive serology. HCV was detectable on two occasions, and histology showed mild disease - A1F1. Upon follow up and without any treatment, the patient achieved spontaneous clearance confirmed by two consecutive undetectable HCV RNA tests. Spontaneous HCV clearance rarely occurs – 0.5% per person-year. This is sometimes accompanied by special circumstances like additional disease or medical interventions. Host factors like gender and interleukin-28B polymorphisms have been known to contribute to clearance. Viral factors like HCV RNA levels are also a factor. The characteristics of host-viral interplay – age of acquisition and fibrosis stage – cannot be overlooked.
 CONCLUSION: All of the abovementioned factors contribute to the complex immunological interaction between virus and host and the result, although rarely can be spontaneous clearance.

Different HCV Exposure Drives Specific miRNA Profile in PBMCs of HIV Patients

“…The PD-L1 (and its receptor PD-1) is an immune inhibitory factor that blocks cytokine secretion, and therefore, tumor cell apoptosis is the leading cause for cancer escape. The blockage of PD-L1 and PD-1 is closely associated with immune activation and HCV viremia reduction [ 48 ]. Therefore, our results indicate that miRNA profile dysregulation highlights the molecular consequences due to HCV resolution, although further investigations are needed to decipher the long-term consequences of HCV spontaneous clearance and cancer-related events.…”