Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection
Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection
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DOI：
10.1002/hep.510290311
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发表时间：
1999-03-01
期刊：
影响因子：
13.5
通讯作者：
Thomas, DL
中科院分区：
文献类型：
--
作者：
Villano, SA;Vlahov, D;Thomas, DL
这项研究的目的是前瞻性地描述急性丙型肝炎病毒(HCV)感染的特征，并评估预后受可识别的临床或病毒因素影响的假设。1988年有非法吸毒史的丙型肝炎病毒抗体阴性的142人每半年进行一次随访，直到1996年，43人(30%)丙型肝炎病毒血清转换(第二代酶免疫试验和重组免疫印迹试验)被确认，平均随访时间为72个月。用聚合酶链式反应在每个参与者的中位数10个样本中检测和定量了丙型肝炎病毒RNA，并显示出两种不同的病毒血症模式：6名参与者(14%)的病毒清除，37名参与者(86%)的病毒持续。病毒清除的受试者更有可能是白人(P=.004)、黄疸(P=.03)和较低的病毒滴度峰值(P=.003)，然而，不能通过临床特征、RNA水平或丙型肝炎病毒亚型(通过分析核心-F1互补DNA序列来确定)来预测特定人的结局。卫生保健提供者没有发现任何急性感染。在血清转换时，81%的参与者可检测到丙型肝炎病毒RNA，85%的参与者重组免疫印迹试验(RIBA)呈阳性。我们得出结论，大约85%的急性丙型肝炎患者会出现持续性病毒血症。然而，急性感染在临床上并不常见，这突显了筛查高危人群的重要性。长期随访是必要的，但不是单一的实验室测试，以确定结果，在某些情况下作出急性丙型肝炎病毒感染的诊断。
The purpose of this investigation was to prospectively characterize acute hepatitis C virus (HCV) infections and to evaluate the hypothesis that the outcome is affected by identifiable clinical or viral factors. One hundred forty-two people with a history of illicit drug use who were HCV antibody-negative in 1988 were followed semiannually through 1996, HCV seroconversion (second generation enzyme immunoassay and recombinant immunoblot assay) was recognized in 43 (30%) of the participants, who were followed up for a median of 72 months. HCV RNA was detected and quantified by polymerase chain reaction in a median of 10 specimens per participant and showed two distinct patterns of viremia: viral clearance was noted in 6 (14%) of the participants, and viral persistence was observed in 37 (86%) of the participants. Subjects with viral clearance were more likely to be white (P =.004), have jaundice (P =.03), and have lower peak viral titer (P =.003), However, the outcome for a given person could not be predicted by clinical features, RNA level, or HCV subtype (as ascertained by analysis of core-Fl complementary DNA sequence). No acute infections were recognized by health care providers. At the time of seroconversion, HCV RNA was detectable in 81% of participants, and recombinant immunoblot assay (RIBA) was positive in 85% of participants. We conclude that approximately 85% of people with acute hepatitis C develop persistent viremia. However, acute infections are uncommonly recognized clinically, underscoring the importance of screening individuals at risk. Long-term follow-up, but no single laboratory test, is necessary to ascertain the outcome and in some cases make the diagnosis of acute HCV infection.