JAUNDICE AT ONSET SIGNIFIES A GOOD PROGNOSIS IN ANTI-D-ASSOCIATED HCVINFECTION

Introduction: Acute hepatitis presenting with jaundice occurs in less than a quarter of patients infected with the hepatitis C virus (HCV). These patients may be associated with a more benign clinical course th an those who are asymptomatic. Objective: To compare and contrast the polymerase chain reaction (PCR) and recombinant immunoblot assay (RIBA ) status, serum alanine aminotransferase (ALT) levels and histological scores in age, disease duration and viral load matched HCV anti-D rec ipients with and without a history of jaundice. Methods: HCV status wa s confirmed by detecting HCV-RNA by PCR and antibodies to HCV using en zyme-linked immunosorbent assay (ELISA) and RIBA-3. Serum ALT levels w ere measured in all patients and a liver biopsy was performed in 26/34 patients. All patients were genotyped. Results: Fourteen out of 17 ja undiced patients were PCR negative and only 4/17 had RIBA scores great er than 9, whereas all non-jaundiced patients were PCR positive and al l 17 had RIBA scores greater than 9. Thirteen out of 17 jaundiced pati ents had normal ALT values, 3/17 mildly elevated (41-100) and 1/17 gre ater than 100; 6/17 non-jaundiced patients had normal ALT levels, 9/17 mildly elevated (41-100) and 2/17 greater than 100; 7/9 jaundiced pat ients had mild histological scores, 0/9 moderate and 2/9 severe; 5/17 non-jaundiced patients had mild, 9/17 moderate and 3/17 severe histolo gical scores. All 34 patients were of genotype 1b. Conclusion: Patient s with jaundice had lower antibody scores, increased PCR negativity, n ormal serum ALT levels and low/normal histological scores. Jaundice at onset was an indicator of good prognosis.