Reuters Health Information (2004-10-28): Early immune response plays key role in hepatitis C clearance
Early immune response plays key role in hepatitis C clearance
Last Updated: 2004-10-28 9:55:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A negative hepatitis C
virus (HCV) RNA test and a broad cell-mediated immune response during
the first month of infection are good predictors of viral clearance,
according to a report in the November issue of Gut.
"Understanding the virus host interactions, which enable a
proportion of patients with acute infection to clear HCV, is probably a
key to the development of more effective treatment and prevention
strategies," the authors explain.
Dr. E. Spada from National Center of Epidemiology, Rome, and
colleagues in the Acute Hepatitis C Italian Study Group followed the
clinical course of 34 consecutive patients with acute hepatitis C.
Nine of 10 patients with a self-limiting infection had a negative
HCV RNA test within the first month of symptom onset, the authors
report, compared with 4 of 24 patients who developed chronic HCV
infection (p < 0.01).
A greater proportion of women (5/7) than men (5/27) experienced a
self-limiting course, the report indicates, and patients who achieved a
normal ALT level early and a higher median peak bilirubin level were
more likely to have a self-limiting course of the disease. After
adjusting for "age, sex, ALT and bilirubin levels at the onset, the
only independent factor associated to a self self-limiting course of
acute hepatitis C was female sex," the investigators report.
Strong T cell responses to multiple HCV antigens during the early
phase of acute HCV infection was also associated with resolution of the
infection, the researchers note (p < 0.01).
HLA class II type was not significantly associated with HCV
outcomes, the results indicate, but HLA-DRB1*1101 was more frequent in
resolving patients and was the allele detected in two women with the
strongest and broadest T cell response.
"These findings suggest that repeated evaluation of HCV RNA status
until the third month from the onset of disease can serve as a good
predictor of the outcome of the infection and can be used as a useful
criterion to decide the beginning of antiviral treatment," the
"By implementing a T cell assay together with RNA detection tests
within the first month from the onset of symptoms," the authors
conclude, "one could select with high diagnostic sensitivity a group of
patients with high probability to resolve the infection, preventing
them having to undergo an early antiviral treatment."
"If such a combined test failed in predicting a favorable course,"
the researchers add, "treatment could still achieve high frequency of
sustained virological response if started within the first 6 months
from disease onset."