Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load
Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load
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DOI：
10.1053/jhep.2003.50019
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发表时间：
2003-01-01
期刊：
影响因子：
13.5
通讯作者：
Ferenci, P
中科院分区：
文献类型：
--
作者：
Hofer, H;Watkins-Riedel, T;Ferenci, P
早期干扰素（IFN）治疗可防止急性丙型肝炎病毒的持续存在，但鉴于由此产生的费用和发病率，必须确定真正需要治疗的患者。研究了12例连续的急性丙型肝炎患者（9例女性，3例男性，平均年龄：39.5±18.8岁，基因型1:7，基因型3a: 3, 2例无法分型）。感染源为医疗程序感染6例，性传播感染3例，静脉吸毒感染3例。采用Cobas Amplicor HCV Monitor v2.0 （Roche Diagnostic Systems, Branchburg， NY）检测病毒载量。从感染到出现临床症状的时间为43.3 +/- 8.6（平均+/- SD） d。8例患者自行清除丙型肝炎病毒（HCV）， HCV- rna呈阴性，随访时间为9.0 +/- 3.9个月。在这些患者中，病毒载量快速而持续地下降。暴露于HCV-RNA阴性的时间为77.4 +/- 25.3天，首次出现症状的时间为34.7 +/- 22.1天。4例患者HCV-RNA水平居高不下甚至升高。其中两人在6周观察期后对开始的治疗有持续反应。其余2例患者未接受治疗（1例因IFN禁忌症，另1例拒绝治疗），仍为HCV-RNA阳性。总之，急性黄疸型丙型肝炎患者在出现症状后的第一个月内有很高的自发病毒清除率。干扰素治疗似乎只需要在出现症状后35天内未能感染病毒的患者。通过这种方法，三分之二的急性丙型肝炎患者不需要干扰素治疗。
Early interferon (IFN) therapy prevents viral persistence in acute hepatitis C, but in view of the resulting costs and morbidity patients who really need therapy have to be identified. Twelve consecutive patients with acute hepatitis C (9 women, 3 men, mean age: 39.5 +/- 18.8 y, genotype 1: 7, genotype 3a: 3, 2 could not be genotyped) were studied. The sources of infection were medical procedures in 6, sexual transmission in 3, and intravenous drug abuse in 3 patients. Viral load was measured by Cobas Amplicor HCV Monitor v2.0 (Roche Diagnostic Systems, Branchburg, NY). The time from infection to clinical symptoms was 43.3 +/- 8.6 (mean +/- SD) days. Eight patients cleared hepatitis C virus (HCV) spontaneously and remained HCV-RNA negative with a follow-up of 9.0 +/- 3.9 months. In these patients viral load declined fast and continuously. The time from exposure to HCV-RNA negativity was 77.4 +/- 25.3 and from the first symptoms was 34.7 +/- 22.1 days. In 4 patients HCV-RNA levels remained high or even increased. Two of them became sustained responders to treatment initiated after a 6-week observation period. The 2 remaining patients were not treated (one because of contraindications for IFN, the other declined therapy) and are still HCV-RNA positive. In conclusion, patients with acute icteric hepatitis C have a high rate of spontaneous viral clearance within the first month after the onset of symptoms. IFN therapy appears only needed in patients who fail to dear the virus within 35 days after onset of symptoms. By this approach, IFN therapy was not necessary in two thirds of patients with acute hepatitis C.