Hepatitis C virus (HCV) remains a public health problem of global
importance, even in the era of potent directly-acting antiviral drugs. In this
chapter, I discuss immune response to acute and chronic HCV infection. The
outcome of HCV infection is influenced by viral strategies that limit or delay
the initiation of innate antiviral responses. This delay may enable HCV to
establish widespread infection long before the host mounts effective T and B
cell responses. HCV’s genetic agility, resulting from its high rate of
replication and its error prone replication mechanism, enables it to evade
immune recognition. Adaptive immune responses fail to keep up with changing
viral epitopes. Neutralizing antibody epitopes may be hidden by decoy
structures, glycans, and lipoproteins. T cell responses fail due to changing
epitope sequences and due to exhaustion, a phenomenon that may have evolved to
limit immune-mediated pathology. Despite these difficulties, innate and adaptive
immune mechanisms do impact HCV replication. Immune-mediated clearance of
infection is possible, occurring in 20–50% of people who
contract the disease. New developments raise hopes for effective immunological
interventions to prevent or treat HCV infection.