Antibody response to core, envelope and nonstructural hepatitis C virus antigens: Comparison of immunocompetent and immunosuppressed patients

Abstract

Some immunosuppressed patients with hepatitis C virus infection do not have detectable levels of antibody to hepatitis C virus on second-generation enzyme immunoassay. Antibodies to the envelope and nonstructural region 5 proteins have not been examined. Four groups of patients with hepatitis C virus infection were studied: (a) 20 immunocompetent patients, (b) 15 hemodialysis patients, (c) 17 kidney transplant recipients and (d) 3 acute leukemia patients who underwent bone marrow transplantation. Serum samples were tested for antibody to hepatitis C virus with a second-generation enzyme immunoassay and multi-antigen enzyme immunoassays and for hepatitis C virus RNA with a nested polymerase chain reaction assay. All the immunocompetent patients reacted to C25, C22 and C33C; 90% reacted to nonstructural region 5 antigen and 80% reacted to C100-3. Only 55% reacted against yeast-derived e1 and e2 antigens, but all reacted against vaccinia virus--expressed N e1 and e2 antigens, indicating that the envelope epitopes are conformational and glycosylated. Sixty-five percent to 90% of dialysis and kidney transplant patients reacted to C25, C22 and N e1 and e2, but only 12% to 60% reacted to C100-3, C33C and nonstructural region 5 antigen. Diminution or loss of reactivity to hepatitis C virus antigens was observed after kidney and bone marrow transplantation, with C25 and N e1 and e2 less affected. Our data suggest that incorporation of C25 and N e1 and e2 antigens in the assay for antibody to hepatitis C virus would improve the detection of hepatitis C virus infection in immunosuppressed patients.

Hepatitis C virus in long-term bone marrow transplant survivors

“…During this phase, detection of anti-HCV alone is insufficient to provide a diagnosis. 19 On the other hand, Tada et al 18 found no HCV-RNA-positive patient who tested negative by a second generation EIA. Most likely, the BMT patients in their study were no longer immunosupressed.…”

“…5 Other papers analyze the results of serological tests in BMT and immunocompromised patients. 10,15,[17][18][19][20][21][22][23] Toma´s et al 23 found in a retrospective study of 61 BMT patients who had hepatic pathology, 29 patients with chronic hepatitis C of whom seven constantly tested anti-HCV negative but PCR positive. The Seattle group recommends hepatitis C testing, including viral RNA analysis.…”

Management of Hepatitis C Infection in Renal Transplant Recipients

“…In this case, they remain anti-HCV-negative despite being viremic, i.e. positive for HCV RNA, and the diagnosis of HCV infection would have been missed if only anti-HCV testing were performed (15)(16)(17)(18). Indeed, HCV RNA can be detected in about 9-18% of the anti-HCV-negative renal transplant recipients (16,19).…”

Evidence-based consensus on the diagnosis, prevention and management of hepatitis C virus disease

“…Replication of HCV is detectable only by the third generation EIAs that has been profoundly observed in hemodialysis and immunodepressed patients [13,14] . In a research study, Bcell epitopes and antigenic regions were recognized after cloning the genome of the HCV [6] .…”