CLINICAL-SIGNIFICANCE OF INTRAHEPATIC HEPATITIS-C VIRUS LEVELS IN PATIENTS WITH CHRONIC HCV INFECTION

Background-The clinical significance of a single assessment of circula ting hepatitis C virus (HCV) RNA and its relation to the level of intr ahepatic HCV RNA remains unclear. Aims-To investigate the relation bet ween intrahepatic HCV levels and clinicopathological characteristics o f chronic HCV infection. Patients-Ninety eight consecutive patients wi th chronic HCV infection were studied; none had received alpha interfe ron therapy Of these, 12 patients were repeatedly negative for HCV RNA in serum by reverse transcriptase polymerase chain reaction (RT-PCR). Methods-After diagnostic laparoscopy and liver biopsy, semiquantitati ve analysis of intrahepatic HCV RNA levels was carried out by limiting dilution of HCV cDNA. HCV genotypes were assessed in 96 patients by r estriction fragment length polymorphism analysis of HCV cDNA. Results- Ten out of 12 patients who were RT-PCR negative for HCV RNA in serum w ere RT-PCR positive in liver; however, this group had a significantly lower intrahepatic HCV level and serum aminotransferase level than the remaining 86 patients. Histological severity (cirrhosis: n=10); histo logical activity index; HCV genotype (genotype 1: n=41; genotype 2: n= 12; genotype 3: n=36; genotype 4: n=7); mode of infection (intravenous drug abuse: n=58; post-transfusion: n=10; haemophiliac: n=4; sporadic : n=26) and alcohol abuse did not affect the intrahepatic virus level. There was no correlation between patient age, duration of infection, and intrahepatic HCV level. Conclusions-Intrahepatic virus levels were not determined by host factors (age of patient, mode or duration of i nfection) or by virus factors (HCV genotype). Repeatedly negative RT-P CR for HCV RNA in serum does not indicate absence of HCV from the live r.