Immunoglobulin GM and KM allotypes-genetic markers of ␥ and chains, respectively-are associated with immune responsiveness to several infectious pathogens and with survival in certain viral epidemics. We hypothesized that GM and KM allotypes affect the outcome of hepatitis C virus (HCV) infection. To test this hypothesis, we serologically allotyped 100 persons with well-documented clearance of HCV infection and 198 matched persistently infected persons. None of the GM or KM phenotypes by itself was associated with the clearance or persistence of HCV infection. Particular combinations of these phenotypes, however, were significantly associated with the outcome of HCV infection. Subjects with GM 1,17 5,13 and KM 1,3 phenotypes were over three times (odds ratio Hepatitis C virus (HCV) is a major health problem, affecting over 170 million people worldwide (47). Of persons acutely infected with HCV, about 15% spontaneously clear the virus. Among the factors influencing the outcome of HCV infection, the host genetic factors are thought to play a predominant role. Reports from several studies documenting consistent associations of particular HLA alleles with viral persistence and clearance support this contention (40,41,43). Allelic variation at the HLA loci, however, accounts for only a small percentage of the total interindividual variation in the outcome of HCV infection (41), suggesting involvement of additional genetic factors that might modify the host immune responsiveness to this pathogen.[Immunoglobulin (Ig) GM and KM allotypes-hereditary antigenic determinants of IgG heavy chains and -type light chains, respectively-are associated with viral immunological properties and thus are ideal candidate genetic systems for investigations to identify risk-conferring factors in HCV pathogenesis. GM and KM allotypes are associated with the susceptibility to and outcome of infection by several infectious agents (1-3, 6-13, 21, 23-26, 28-30, 33, 35). GM allotypes are strongly associated with IgG subclass concentrations (19,22,27,34), making them relevant to viral immunity, as the antibody responses to most viral epitopes appear to be IgG subclass (IgG1 and IgG3) restricted (15,37,39).These observations led us to hypothesize that GM and KM allotypes might contribute to the outcome of HCV infection through their possible influence on allotype-restricted antibody responses to the viral antigens. In addition, since particular GM and KM phenotypes have been shown to interact in influencing humoral immunity to certain viral epitopes (1), we wished to determine whether such epistatic interactions were associated with the outcome of HCV infection.
MATERIALS AND METHODSStudy population. Between 1988 and 1989, a cohort was recruited in Baltimore, Md., of persons who had injected illicit drugs in the preceding 10 years, were more than 17 years of age, and were free of manifestations of AIDS (44). Within this cohort, a subset of 1,667 individuals was identified as the HCV subcohort because they had antibodies to HCV and had made at le...