Spontaneous elimination of hepatitis C virus RNA in individuals with persistent infection in a hyperendemic area of Japan

doi:10.1016/j.hepres.2005.10.004

Hepatology Research

Volume 34, Issue 1, January 2006, Pages 28-34

https://doi.org/10.1016/j.hepres.2005.10.004 Get rights and content

Abstract

The natural course of hepatitis C virus (HCV) carriers is not well understood. We examined the clinical characteristics of individuals exhibiting spontaneous elimination of HCV as part of a cohort study of residents of a HCV hyperendemic area in Japan. In individuals who were judged to have persistent HCV infection in 1995, 302 had at least 4 annual ALT measurements between 1993 and 2000, and had not been treated with IFN. They were tested for the presence of HCV RNA in 2001 and/or 2002 and HCV RNA could not be detected in 20 of the 302 individuals. In these 20 individuals, 7 were confirmed to have detectable HCV RNA and 13 were not until 2000. Thus, 2.4% (7/289) were judged to have spontaneously eliminated the HCV infection during that 6-year period. Although there were no differences in age, sex, ALT levels, or serologically defined HCV genotype between individuals with and without exhibiting spontaneous elimination, there was a significant relationship between the elimination of HCV RNA and a low level of HCVcAg (<20 pg/mL) (P < 0.001) upon testing in 1995. These results suggest that spontaneous elimination of HCV RNA following persistent infection is rare and appears to be related to viral load.

Introduction

Hepatitis C virus (HCV) infection is one of the most common causes of acute or chronic liver diseases, including chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC) [1], [2]. Persistent viral infection is estimated to occur in approximately 40–60% of patients with symptomatic acute hepatitis C [3], [4]. The clinical features and progression of HCV in these carriers, however, have not been fully characterized.

Although the spontaneous elimination of HCV is thought to be rare in individuals with persistent viral infection in comparison to those with acute disease, the reported frequencies have varied considerably [5], [6], [7], [8], [9]. Furthermore, spontaneous elimination during chronic infection has been reported to be related to several factors, such as age, sex, parturition, additional surgical procedure, or stages of HCC [6], [7], [8], [9], [10]. The occurrence of elimination and the associated predisposing factors in the general population, however, have not been examined sufficiently.

In this study, we sought to elucidate the clinical and virological features of individuals with persistent HCV infection in a hyperendemic population of Japan. We also evaluated the frequency of spontaneous elimination of chronic HCV infection in this population.

Section snippets

Study population

Town C is a small town in midwestern Miyazaki Prefecture, Japan, located in a rural area isolated by densely forested mountains. Farming is the principal occupation. A local government-sponsored general health examination program, begun in 1993, has been conducted annually for residents over 20 years of age. Collected blood samples were sent to a commercial laboratory in Miyazaki City for routine blood chemistry analyses. Additional blood samples were stored at or below −30 °C until testing. As

Prevalence of anti-HCV positivity

Initial testing of Town C demonstrated an overall prevalence of anti-HCV antibody positivity of 20.6% (1151/5577), which gradually increased with age (Table 1). There were no differences in the prevalence of anti-HCV antibody positivity between males and females. Eight hundred thirty-six of the 1151 anti-HCV antibody-positive individuals were tested for HCVcAg levels in 1995, at least 6 months after the measurement of anti-HCV antibody titers. Five hundred twenty-eight (63.2%) of those tested

Discussion

This study was performed in an area of Japan hyperendemic for HCV infection, where the prevalence of anti-HCV antibody positivity is 4- to 12-fold higher than that seen in the surrounding areas. The frequency of anti-HCV antibody positivity in this community is similar to that reported for other endemic areas of Japan [5]. In this population, as most residents displayed asymptomatic infections, with less than 5% reporting a history of acute hepatitis or jaundice (data not shown), the exact date

Acknowledgments

This work was supported in part by a grant (no. CA87982) from the United States National Institutes of Health and by a grant-in-aid (Research on Hepatitis and BSE) from the Ministry of Health, Labour, and Welfare, Japan. We thank Ms. Keiko Toyama and Ms. Yuriko Kuwabara for their technical assistance.

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Spontaneous elimination of hepatitis C virus RNA in individuals with persistent infection in a hyperendemic area of Japan

Abstract

Introduction

Section snippets

Study population

Prevalence of anti-HCV positivity

Discussion

Acknowledgments

Lancet

J Hepatol

Am J Gastroenterol

J Hepatol

Hepatology

J Hepatol

J Virol Methods

The prevalence of hepatitis C virus infection in the United States 1998 through 1994

N Engl J Med

Estimating future hepatitis C morbidity, mortality, and costs in the United States

Am J Public Health

Different clinical behaviors of acute hepatitis C virus infection are associated with different vigor of the anti-viral cell-mediated immune response

J Clin Invest