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Relationship between virological evolution and acute exacerbation of chronic hepatitis C (A-E-CHC) and during the natural history of infection

Abstract number: 1733_1392

Sagnelli E., Argentini C., Genovese D., Pisaturo M., Sagnelli C., Taffon S., Alteri C., Coppola N., Rapicetta M.

Objectives: To evaluate the relationship between symptomatic a-e-CHC and virological evolution during the natural course of the disease.

Methods: 49 consecutive patients with acute hepatitis C (AHC) (55% IVDA) and 57 with a-e-CHC (43.8% IVDA) were observed. AHC was diagnosed on the basis of seroconversion to anti-HCV and of the increase in ALT serum levels of at least 5 times the normal value. The diagnosis of a-e-CHC was based on the presence of anti-HCV and HCV-RNA in the blood at least 6 months before the onset of symptoms and during exacerbation and of increased ALT serum values of at leas 5 times the baseline at exacerbation. Several plasma samples were obtained and stored frozen at -80°C. Three patient followed-up for 40–68 months showed both AHC and a-e-CHC 3–24 months later. In these patients we evaluated clinical characteristics, viral variability and the variation of known predicted epitopes in the consensus sequence in the Core, E1/E2, and NS5b regions, during the different phases of infection.

Result: The first patient (genotype 3) presented a high rate of genetic and epitopic variability which could be related to the maintenance of a chronic HCV infection state. The second patient (genotype 1b) presented an apparent resolution of the infection with absence of detectable viraemia after a symptomatic acute phase; the phylogenetic and epitopic analysis of the virus isolate during a-e-CHC presented little variation with the isolate of AHC, indicating a phase of occult presence of the virus in the period between AHC and a-e-CHC. The third patient presented two different HCV genotypes, 2c and 2a, associated with the initial phase of AHC and with a-e-CHC, respectively.

Conclusion: The follow up analysis revealed that, despite similar clinical presentation, the viral variability and the differences in the ability to develop or select epitopic variants may drive HCV infection toward different outcomes.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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