Testing (HCV); Those with No HCV RNA May Have Cleared Virus
Hepatitis Weekly via Individual Inc. :
People with confirmed hepatitis C virus (HCV) infection who have
persistently normal liver tests and undetectable HCV RNA have
probably spontaneously cleared HCV infection, according to a report
from southern California.
Confirmed anti-HCV reactive blood donors with normal alanine
aminotransferase (ALT) may or may not have detectable HCV RNA in
serum. Earlier research has suggested that the presence of HCV RNA
in the serum is often associated with some degree of hepatic
necro-inflammatory activity. "Anti-HCV reactive patients with
persistently normal liver tests, but without detectable HCV RNA in
the serum, may have occult chronic hepatitis C infection, or have
recovered from previous hepatitis C infection," researcher Tse-Ling
Fong and colleagues wrote ("Clinical Significance of HCV RNA Status
and its Correlation to Antibodies to Structural HCV Antigens in
Anti-HCV Reactive Patients with Normal Liver Tests," Journal of
Medical Virology, July 1996;49:253-258).
"We undertook this study to determine the clinical significance
of anti-HCV antibodies in patients with persistently normal liver
tests; some of whom had detectable HCV RNA in serum and some who
did not." Extensive serological testing and HCV RNA determination
by RT-PCR was performed in serum, peripheral blood mononuclear
cells (PBMC), and liver tissue in thirteen anti-HCV reactive
patients with persistently normal liver tests. Absolute concordance
in the status of HCV RNA between serum, PBMCs and liver was
noted.
Five patients were HCV RNA positive but only three had mild
histological changes. Eight patients were HCV RNA negative in all
three sites and had virtually normal liver histology.
Patterns of reactivity in RIBA 2.0 strip immunoblot assay did
not differentiate viremic from nonviremic patients. ELISA testing
using multiple individual HCV recombinant antigens from the
structural and non- structural regions of HCV demonstrated mean
antibody titers to the structural antigens, in particular HCV E2
antibodies, to be significantly lower in HCV RNA negative
patients.
"The status of HCV RNA in the serum appears to infer the status
of HCV RNA in the liver and PBMCs in patients with persistently
normal liver tests," Fong et al. wrote.
The researchers suggest that patients with persistently normal
liver tests and undetectable HCV RNA probably have cleared HCV
infection. "We found in our patients with persistently normal liver
tests, that serum HCV RNA correlated absolutely with liver and PBMC
HCV RNA," they wrote. "Patients with no detectable HCV RNA
presumably have had spontaneous resolution of their HCV infection.
Also, the patients we studied, even those who were RNA positive,
had only mild histological changes in the liver. Additionally,
anti-E2 titer appears to be a useful marker of ongoing viral
replication."
The corresponding author for this study is Tse-Ling Fong, USC
Liver Unit, Building 500, Room 114, Ranch Los Amigos Medical
Center, 7601 East Imperial Highway, Downey, California
90242.
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