DIFFERENT CLINICAL BEHAVIORS OF ACUTE HEPATITIS-C VIRUS-INFECTION AREASSOCIATED WITH DIFFERENT VIGOR OF THE ANTIVIRAL CELL-MEDIATED IMMUNE-RESPONSE

The anti-viral T cell response is believed to play a central role in t he pathogenesis of hepatitis C virus infection, Since chronic evolutio n occurs in > 50% of HCV infections, the sequential analysis of the T cell response from the early clinical stages of disease may contribute to define the features of the T cell response associated with recover y or chronic viral persistence, For this purpose, 21 subjects with acu te hepatitis C virus infection were sequentially followed for an avera ge time of 44 wk, Twelve patients normalized transaminase values that remained normal throughout the follow-up period; all but two cleared h epatitis C virus-RNA from serum, The remaining nine patients showed pe rsistent viremia and elevated transaminases. Analysis of the periphera l blood T cell proliferative response to core, E1, E2, NS3, NS4, and N S5 recombinant antigens and synthetic peptides showed that responses t o all hepatitis C virus antigens, except El, were significantly more v igorous and more frequently detectable in patients who hormalized tran saminase levels than in those who did not, By sequential evaluation of the T cell response, a difference between the two groups of patients was already detectable at the very early stages of acute infection and then maintained throughout the follow-up period, The results suggest that the vigor of the T cell response during the early stages of infec tion may be a critical determinant of disease resolution and control o f infection.