Viral Hepatitis: Acute Hepatitis by Resat Ozaras & Joop E. Arends

Author:Resat Ozaras & Joop E. Arends
Language: eng
Format: epub
ISBN: 9783030035358
Publisher: Springer International Publishing

4.2.3 Assays in Clinical Practice

Since there is no definite test to prove an acute infection, physicians usually rely on clinical judgments (i.e., the presence of symptoms) in combination with abnormal laboratory results such as elevated aminotransferases, and a positive HCV-RNA or serology in combination with a prior seronegative assay. In specific circumstances, for example in HIV-infected patients with an acute HCV, antibody generation by the host immune response could be initially absent or delayed for months [108]. Also, successful viral clearance may occur in the absence of antibody production or be associated with rapid antibody loss [93]. This suggests that clearance of viremia may be related to both humoral and cellular responses [109]. Among IDUs some studies suggested an average interval from first injection and HCV infection to the development of HCV Ig antibodies of 1 year or even longer. Factors associated with a shorter interval to seroconversion included injecting every day, the shared use of syringes to inject, and the shared use of a cooker or cotton to prepare drugs for injection [110]. In another study conducted on IDUs a delayed and low-titer antibody response was observed during acute hepatitis C [111].

Another pitfall in the diagnosis of acute HCV in high-risk HIV+ MSM is the distinction between relapse of infection after DAA therapy or reinfection. When the same genotype again is present, it still might be a reinfection. Only phylogenetic analysis can firmly distinguish between these two entities [84].

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