Background and Aims: Acute hepatitis C (AHC) spontaneously resolves in about 30% of patients. However, in the majority of studies regarding the natural history of acute HCV infection, the followup period is generally limited. The aim of this study is to evaluate the long-term evolution of a consecutive cohort of acute hepatitis C patients with spontaneous resolution. Patients and Methods: From 1995 to 2008, 143 acute hepatitis C patients were consecutively observed and enrolled in this study. Diagnosis was based on the documented anti-HCV seroconversion or, in its absence, on the presence of at least two of the following criteria: (a) ALT levels >20 times the upper normal limit; (b) known/suspected exposure to HCV within the previous six months; (c) exclusion of all other causes of acute liver damage. Five patients were lost to followup while 138 patients were observed for at least 12−24 weeks. After this period, the infection had a chronic evolution in 101 patients (73%) with HCV RNA still detectable, while spontaneous resolution was observed in 37 patients (27%), all of whom were followed for a median period of 39 months (range 6–153) and periodically subjected to hematochemical and virological tests. In the first year of followup, ALT levels were monitored every 3 months and HCV RNA levels were assessed every 6 months with a qualitative test (Amplicor HCV, Roche Diagnostic Systems, v2.0, lower detection limit 50 IU/ml). In the second year of follow-up, ALT and HCV and RNA levels were monitored every 6 months and successively every year. Quantification of anti-HCV levels were performed annually with a commercial kit (Architect Anti-HCV, Abbott) and results were expressed as the optic density of the sample/cut-off. Results: During the median follow-up of 39 months, 36/37 patients continued to present normal ALT and HCV RNA undetectable with real-time PCR assay (Taqman Real Time, Roche, detection limit 12 IU/l). Only one patient demonstrated positive HCV RNA after 10 months of follow-up with a successive increase of ALT levels; this was considered as a reactivation of the previous infection as there were no risk factors indicating a new infection and the HCV genotype remained the same. In 21/36 patients, the quantitative determination of anti-HCV levels showed a progressive decline up to complete negativity in two patients. When studying the presence of the RNA negative strand in peripheral blood mononuclear cells (PBMC) of 14/37 patients, we found that 14/14 patients were negative by the strand specific RT-PCR. Conclusions: This study confirmed that the spontaneous resolution of acute hepatitis was long-lasting in all our patients except one. The progressive reduction of the anti-HCV levels, up to negativity in two patients, suggests the possibility of a complete clearance of the HCV infection.
T.N.36 {LONG}-{TERM} {FOLLOW} {UP} {OF} {PATIENTS} {WITH} {ACUTE} {HEPATITIS} C {AND} {SPONTANEOUS} {RESOLUTION}
A. Guastadisegni;P. Leone;V. Racanelli;
2010-01-01
Abstract
Background and Aims: Acute hepatitis C (AHC) spontaneously resolves in about 30% of patients. However, in the majority of studies regarding the natural history of acute HCV infection, the followup period is generally limited. The aim of this study is to evaluate the long-term evolution of a consecutive cohort of acute hepatitis C patients with spontaneous resolution. Patients and Methods: From 1995 to 2008, 143 acute hepatitis C patients were consecutively observed and enrolled in this study. Diagnosis was based on the documented anti-HCV seroconversion or, in its absence, on the presence of at least two of the following criteria: (a) ALT levels >20 times the upper normal limit; (b) known/suspected exposure to HCV within the previous six months; (c) exclusion of all other causes of acute liver damage. Five patients were lost to followup while 138 patients were observed for at least 12−24 weeks. After this period, the infection had a chronic evolution in 101 patients (73%) with HCV RNA still detectable, while spontaneous resolution was observed in 37 patients (27%), all of whom were followed for a median period of 39 months (range 6–153) and periodically subjected to hematochemical and virological tests. In the first year of followup, ALT levels were monitored every 3 months and HCV RNA levels were assessed every 6 months with a qualitative test (Amplicor HCV, Roche Diagnostic Systems, v2.0, lower detection limit 50 IU/ml). In the second year of follow-up, ALT and HCV and RNA levels were monitored every 6 months and successively every year. Quantification of anti-HCV levels were performed annually with a commercial kit (Architect Anti-HCV, Abbott) and results were expressed as the optic density of the sample/cut-off. Results: During the median follow-up of 39 months, 36/37 patients continued to present normal ALT and HCV RNA undetectable with real-time PCR assay (Taqman Real Time, Roche, detection limit 12 IU/l). Only one patient demonstrated positive HCV RNA after 10 months of follow-up with a successive increase of ALT levels; this was considered as a reactivation of the previous infection as there were no risk factors indicating a new infection and the HCV genotype remained the same. In 21/36 patients, the quantitative determination of anti-HCV levels showed a progressive decline up to complete negativity in two patients. When studying the presence of the RNA negative strand in peripheral blood mononuclear cells (PBMC) of 14/37 patients, we found that 14/14 patients were negative by the strand specific RT-PCR. Conclusions: This study confirmed that the spontaneous resolution of acute hepatitis was long-lasting in all our patients except one. The progressive reduction of the anti-HCV levels, up to negativity in two patients, suggests the possibility of a complete clearance of the HCV infection.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
