Prospective evaluation of community-acquired acute-phase hepatitis C virus infection
Prospective evaluation of community-acquired acute-phase hepatitis C virus infection
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DOI：
10.1086/428578
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发表时间：
2005-04-01
影响因子：
11.8
通讯作者：
Thomas, DL
中科院分区：
文献类型：
--
作者：
Cox, AL;Netski, DM;Thomas, DL
背景。在西方国家，超过三分之二的丙型肝炎病毒 (HCV) 感染是由注射吸毒引起的，但有关最常见的 HCV 感染方式的前瞻性临床数据很少，部分原因是急性期 HCV 感染通常无症状。为了表征急性期 HCV 感染，对 179 名 HCV 抗体阴性注射吸毒者进行了前瞻性评估；其中 62 名（34%）患者已发生血清转化。对 20 名血清转化的参与者进行了长期随访，在血清转化之前和之后每月进行一致的采样，从而获得详细的研究结果。 HCV 感染的第一个迹象是血清中存在 HCV RNA，在 45% 和 77% 的患者中，丙氨酸转氨酶水平和总胆红素水平分别升高至大于或等于基线的 2 倍。没有受试者出现黄疸。从初始病毒血症到血清转化的中位时间为 36 天（范围：32-46 天）。在一种情况下，在血清转化前 434 天检测到病毒血症。然而，在其他病例中，没有在血清转化前 163 天检测到 HCV RNA。在病毒持续存在的受试者中，一些受试者在最初检测到病毒血症后 60 天内血液中的 HCV RNA 水平达到稳定，但在其他受试者中，直到 11 年后才明显。在长期病毒清除的受试者中，HCV 早在初始病毒血症后 94 天、晚至 620 天就持续检测不到。结论。这些数据强调了对献血进行核酸筛查以预防丙型肝炎病毒传播的重要性，以及长期随访以确定是否存在病毒持续存在（至少在注射吸毒者中）的重要性。
Background. More than two-thirds of hepatitis C virus (HCV) infections in Western countries are caused by injection drug use, but prospective clinical data regarding the most common mode of HCV acquisition are rare, in part because acute-phase HCV infection is usually asymptomatic.Methods. To characterize acute-phase HCV infection, 179 HCV antibody-negative injection drug users were prospectively evaluated; 62 (34%) of these patients had seroconverted. Twenty of the participants who seroconverted had long-term follow-up with consistent monthly sampling before and after seroconversion, allowing detailed study.Results. The first indication of HCV infection was the presence of HCV RNA in serum, which preceded elevation of alanine transaminase levels and total bilirubin levels to greater than or equal to2 times baseline in 45% and 77% of patients, respectively. No subjects had jaundice. The median time from initial viremia to seroconversion was 36 days (range, 32-46 days). In one instance, viremia was detected 434 days before seroconversion. However, in no other case was HCV RNA detected 163 days before seroconversion. In subjects with viral persistence, a stable level of HCV RNA in the blood was noted in some subjects within 60 days after the initial detection of viremia, but in others, it was not apparent until 11 year later. In subjects with long-term viral clearance, HCV became persistently undetectable as early as 94 and as late as 620 days after initial viremia.Conclusions. These data underscore the importance of nucleic acid screening of blood donations to prevent HCV transmission and of long-term follow-up to ascertain whether there is viral persistence, at least among injection drug users.