The natural course of hepatitis C virus infection 18 years after an epidemic outbreak of non-A, non-B hepatitis in a plasmapheresis centre

摘要

BACKGROUND—The natural history ofhepatitis C virus (HCV) infection is variable and factors determiningthe course of the illness are unclear. 
AIMS—To determine the naturalcourse of HCV infection in a well characterised group of patients 18 years after an epidemic outbreak of non-A, non-B hepatitis at aplasmapheresis centre. 
METHODS—Between 1994 and 1996, 20 of 30 affected individuals were studied. HCV infection was confirmedusing second and third generation ELISA test kits. HCV RNA was detectedby a polymerase chain reaction (PCR) method and HCV genotyping wasperformed by analysing amplicons from the conserved 5'-non-translatedregion generated by nested PCR. Thirty two liver biopsies were carried out in 14patients. 
RESULTS—HCV antibodies weredetected in all subjects. Eighteen patients had abnormal liver enzymesand 17 were HCV RNA positive, all of whom were infected with genotype1a. Ninety per cent of this cohort showed evidence of chronic HCVinfection with 50% having progressive liver disease and 20% cirrhosis18 years after acute onset of non-A, non-B hepatitis. Considerablevariation in disease outcome occurred between individuals and nocorrelation with clinical features of the acute illness was found. 
CONCLUSIONS—Variability in theconsequences of HCV infection in cases infected with the same virussuggests that host factors are important in determining diseaseoutcome. The factors which determine differences in the natural historyof the disease still remain to be elucidated.