Outcome of an outbreak of acute hepatitis C among healthy volunteers participating in pharmacokinetics studies

Abstract

We identified 15 patients with acute hepatitis C (AHC) among 29 healthy volunteers participating in 2 consecutive pharmacokinetics studies. Molecular techniques were used to determine the relatedness of viral strains, whereas clinical and virologic follow-up was started to establish the course and outcome of the acute infection. After presentation, serum liver enzymes and HCV RNA were monitored weekly for 4 months, then monthly for at least 12 months. Liver biopsy was performed 6 to 12 months after AHC diagnosis. Phylogenetic analysis of coding regions for the envelope glycoproteins E1 and E2 was performed. At presentation, all 15 patients tested HCV RNA-positive and had HCV genotype 2c. Phylogenetic analysis indicated a common source of infection. Fourteen patients agreed to be followed prospectively. Infection resolved spontaneously in 8 patients, HCV RNA becoming undetectable by 4 to 5 months after the presumed time of infection in 5 of them and by 8, 13, and 24 months in the remaining 3. Six patients developed chronic infection. Liver biopsies performed in 9 subjects who were HCV RNA-positive 6 months after AHC diagnosis revealed that the prevalent histologic finding was lobular inflammation. In conclusion, our homogeneous cohort showed a wide spectrum of clinical, virologic and histologic features, and, more importantly, short-term outcome differed noticeably despite the common source of infection.

Natural History of Acute Symptomatic Hepatitis Type C

“…Icteric patients tend to have a higher rate of spontaneous viral clearance than those with milder or asymptomatic course. In two recent studies, it was shown that acute symptomatic infection resolved in more than 50% of patients [13,14], whereas the overall recovery from primary HCV infection is believed not to exceed 15% [15]. Our study also confirmed a greater chance for recovery from HCV infection in those with higher aminotransferase activity, especially ALT.…”

Prospective study of viral clearance and CD4+ T-cell response in acute hepatitis C primary infection and reinfection

“…Since up to 53% of patients with acute HC show a self-limiting course of the disease Hofer et al, 2003;Hoofnagle, 2002;Larghi et al, 2002), not all patients with acute HC may require treatment. Patients clearing the virus spontaneously can be identified by measuring viral load frequently during the first weeks of the disease (Hofer et al, 2003;Spada et al, 2004).…”

Acute hepatitis C: diagnosis and management

“…Acute infection is largely asymptomatic with persistent infection developing in 43-86% of the cases [2][3][4][5][6][7][8][9][10][11], and it is likely that the vast majority runs unrecognised for several years until major complications secondary to decompensated liver disease may eventually develop. Fulminant hepatic failure is a rare, if at all associated, complicating event.…”