Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection

Hepatology. 1999 Mar;29(3):908-14. doi: 10.1002/hep.510290311.


The purpose of this investigation was to prospectively characterize acute hepatitis C virus (HCV) infections and to evaluate the hypothesis that the outcome is affected by identifiable clinical or viral factors. One hundred forty-two people with a history of illicit drug use who were HCV antibody-negative in 1988 were followed semiannually through 1996. HCV seroconversion (second generation enzyme immunoassay and recombinant immunoblot assay) was recognized in 43 (30%) of the participants, who were followed up for a median of 72 months. HCV RNA was detected and quantified by polymerase chain reaction in a median of 10 specimens per participant and showed two distinct patterns of viremia: viral clearance was noted in 6 (14%) of the participants, and viral persistence was observed in 37 (86%) of the participants. Subjects with viral clearance were more likely to be white (P =.004), have jaundice (P =.03), and have lower peak viral titer (P =.003). However, the outcome for a given person could not be predicted by clinical features, RNA level, or HCV subtype (as ascertained by analysis of core-E1 complementary DNA sequence). No acute infections were recognized by health care providers. At the time of seroconversion, HCV RNA was detectable in 81% of participants, and recombinant immunoblot assay (RIBA) was positive in 85% of participants. We conclude that approximately 85% of people with acute hepatitis C develop persistent viremia. However, acute infections are uncommonly recognized clinically, underscoring the importance of screening individuals at risk. Long-term follow-up, but no single laboratory test, is necessary to ascertain the outcome and in some cases make the diagnosis of acute HCV infection.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Hepacivirus / classification
  • Hepacivirus / genetics
  • Hepatitis C Antibodies / analysis
  • Hepatitis C, Chronic / genetics
  • Hepatitis C, Chronic / immunology
  • Hepatitis C, Chronic / virology*
  • Humans
  • Immunoblotting
  • Jaundice / virology
  • Longitudinal Studies
  • Male
  • Phylogeny
  • Polymerase Chain Reaction
  • RNA, Viral / analysis
  • Viremia / complications
  • Viremia / genetics
  • Viremia / immunology
  • Viremia / virology*


  • Hepatitis C Antibodies
  • RNA, Viral