Hepatitis C virus (HCV) exists as a swarm of genetically distinct but related variants, or a quasispecies, whose complexity and sequence evolution are critical to studies of viral pathogenesis. Because most studies of the HCV quasispecies have focused on a relatively small genomic segment, the first hypervariable region of the E2 gene, it is possible that viral complexity is occasionally underestimated (due to primer mismatch) and that sequence evolution is misperceived due to unrecognized covariation. This report describes a sensitive and reproducible method to amplify most of the HCV genome as a single 5.2-kb amplicon by using primers directed at relatively conserved genomic segments. Using 52 specimens obtained during acute infection over a range of viral RNA concentrations, the overall rate of successful amplification was 94% and varied in a concentrationdependent manner, with successful amplification in 26 of 26 (100%) specimens at greater than 10 5 IU/ml, 15 of 16 (94%) at 10 4 to 10 5 IU/ml, 6 of 7 (86%) at 10 3 to 10 4 IU/ml, and 2 of 3 (67%) at less than 10 3 IU/ml. Quasispecies complexity, determined by using this novel long-amplicon method followed by heteroduplex mobility assay combined with single-stranded conformational polymorphism (HDA؉SSCP) analysis, was very high, even during acute HCV infection, when 10 to 21 (median, 16) different HDA؉SSCP patterns were detected among 33 cDNA clones examined. Replicate analyses indicate that this diversity is not dominated by random errors generated during amplification. Therefore, the HCV quasispecies is highly complex even during acute infection and is accurately represented in amplicons representing more than half of the viral genome.Hepatitis C virus (HCV) is a medically important human pathogen, infecting about 170 million persons worldwide and representing the single most common cause of liver disease requiring liver transplantation in the United States (2, 3, 34). The viral or host factors that determine the course of HCV infections are unclear, and these studies have been hampered by the lack of a well-characterized small-animal model. Observational studies of infected humans are feasible because of the high prevalence of HCV infection but are limited by small amplicons obtained by conventional reverse transcription-PCR (RT-PCR) methods. Amplification of small genomic segments of HCV by RT-PCR is commonplace and demonstrates the presence of a viral quasispecies or a swarm of genetically related but distinct variants (23).HCV sequence variation is informative, because HCV replicates at high levels while employing its error-prone polymerase and appears to tolerate sequence variation and also because infected individuals apply various selective pressures on the virus. This information will be most valuable if examined longitudinally and comprehensively. Such studies of simian immunodeficiency virus-infected macaques have revealed evidence of immune escape. These studies depended in part on an inbred population of animals. In studies of humans, larger reg...