Hepatitis C Infection in Dutch HIV-Positive Patients in the Era of Direct-Acting Antiviral Therapy

Résumé fourni par la source

Acute hepatitis C infectionPatients who become infected with hepatitis C virus can develop abnormal laboratory findings in the following order: detectable HCV RNA, then elevation in ALT, followed by HCV antibodies 30 .After inoculation there is a variable incubation period depending on transmission mode.High level viremia occurs usually within 1-2 weeks after inoculation in transfusion hepatitis cases, needle stick injuries or experimentally inoculated chimpanzees [31][32][33] .However, it is unknown if this can be extrapolated to low-inoculum infections.Fluctuation in HCV RNA levels has been reported as a hallmark of the viral dynamics in the early stages of HCV infection and some patients may even become temporarily HCV RNA negative [34][35][36][37] .There is a considerable heterogeneity among individuals, as some patients may show quite high HCV RNA levels, some patients may show spontaneous clearance beyond six months or have a large HCV RNA decline during acute HCV infection without spontaneous clearance 34 .Within 40-50 days after high level viremia, ALT levels will start to rise, showing that there is some degree of liver cell injury 31,38 .The elevation of aminotransferases varies greatly between individuals.High ALT levels seem to be correlated with seroconversion 31,38 , however, in some patients, especially in HIV-coinfected patients, seroconversion can be delayed.In a series with 43 HIV-positive patients with acute HCV infection, after three months 37% of patients still had a negative antibody test.After 9 months, 10% of patients still had a negative antibody test 39 .In fact, some patients stay undetectable for antibodies for years 40 .Acute hepatitis is most often asymptomatic, most patients do not develop icterus and fulminant hepatitis is rare.A study that was designed to include symptomatic patients infected with HCV, reported non-specific symptoms like jaundice, influenza like symptoms, dark urine, discoloured stools, nausea and discomfort in the right upper quadrant of the abdomen 41 .However, due to the subclinical course of HCV infection, and the fact that symptoms of an acute HCV infection are non-specific, it is important to screen high risk groups.Case definitions for acute hepatitis C virus infection vary considerably between studies 42 .

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.