Reuters Health Information (2005-03-29): Time to seroconversion after acute HCV infection variable in injection drug users
Time to seroconversion after acute HCV infection variable in injection drug users
Last Updated: 2005-03-29 9:44:12 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Data from a long-term
prospective investigation of acute-phase hepatitis C virus infection
among injection drug users show that seroconversion may occur 2 months
after detection of viremia. The findings "underscore the importance" of
nucleic acid screening of blood donations to prevent HCV transmission,
The data also reaffirm the need to follow HCV-positive injection drug users long-term to check for viral persistence.
Among 179 HCV antibody-negative injection drug users followed in the
study, an "alarming" 34% seroconverted despite risk reduction
counseling, Dr. Andrea L. Cox, from the Johns Hopkins Medical
Institutions in Baltimore, Maryland, and colleagues report in the April
1st issue of Clinical Infectious Diseases.
As expected, acute-phase HCV infection was largely asymptomatic.
"Viremia was the earliest marker of acute-phase HCV infection,
preceding detection of HCV-specific antibodies by 5-6 weeks, and in 1
case, by > 12 months," they report. However, in all other cases HCV
RNA was detected no more than 63 days before seroconversion.
Alanine transaminase, while uniformly elevated during acute-phase
HCV infection, did not correlate closely with HCV RNA levels or viral
persistence. Bilirubin levels were also elevated during acute-phase HCV
infection but no patient had jaundice.
In cases of viral persistence, a stable serum level of HCV RNA was
noted in some individuals within 2 months after the first detection of
viremia, while in others, it was not apparent until more than 1 year
In cases of viral clearance, on the other hand, HCV became
persistently undetectable as early as 94 days and as late as 620 days
after initial viremia.
In an editorial, Drs. Michael P. Busch and Kimberly A. Page Shafer
from the University of California in San Francisco say these data show
that clearance of acute-phase viremia can occur "much later than has
been observed in transfusion recipients."
For now, routine HCV RNA or HCV antigen screening outside of the
context of donor screening and research protocols is "probably
premature" for many reasons, including "the controversy over the merits
of early treatment," they add.
They remind clinicians that the most recent guidelines from the
American Association for the Study of Liver Diseases with respect to
acute-phase HCV infection state that "no definitive recommends can be
made regarding early detection and treatment."
Clin Infect Dis 2005;40:951-958.