Hepatitis C Virus Infection And Immunity

William L Irving, Department of Microbiology, University of Nottingham, Nottingham, UK

Hepatitis C virus (HCV) was first characterized in 1989, following successful cloning from copy DNA extracted from infectious chimpanzee plasma. The natural route of infection is unknown, but HCV is blood borne, and therefore high-risk groups for infection include intravenous drug users and recipients of unscreened blood and blood products (e.g. hemophiliacs). Sexual transmission does not appear to be a major route of spread of infection. Vertical transmission from carrier mothers is around 2-10%. Estimates of the prevalence of infection vary between 0.1 and 1% of the population of Europe and the USA. There may be significant fluctuations from this in other countries - for example, rates of 15-20% anti-HCV positivity have been reported in Egypt. The majority (possibly 75%) of HCV infections result in chronic carriage of the virus. The percentage of chronic carriers who will progress to clinically significant liver disease (chronic hepatitis, cirrhosis, hepatocellular carcinoma) is unknown, but a conservative estimate is 20%. HCV infection is also associated with autoimmune phenomena such as the anti-LKM-1 reactivity of autoimmune hepatitis type 2, and the development of mixed essential cryoglobulinemia type II. Viral and host factors which determine the variability in clinical outcome are poorly understood. Current therapy (interferon a, IFNa) is expensive, prolonged (6-12 months) and has a 'cure' rate of only 20%. More encouraging results have been reported in small-scale trials of combination therapy comprising IENa plus ribavirin.

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