Cox Andrea L, Netski Dale M, Mosbruger Timothy, Sherman Susan G, Strathdee Steffanie, Ompad Danielle, Vlahov David, Chien David, Shyamala Venkatakrishna, Ray Stuart C, Thomas David L
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Clin Infect Dis. 2005 Apr 1;40(7):951-8. doi: 10.1086/428578. Epub 2005 Mar 3.
More than two-thirds of hepatitis C virus (HCV) infections in Western countries are caused by injection drug use, but prospective clinical data regarding the most common mode of HCV acquisition are rare, in part because acute-phase HCV infection is usually asymptomatic.
To characterize acute-phase HCV infection, 179 HCV antibody-negative injection drug users were prospectively evaluated; 62 (34%) of these patients had seroconverted. Twenty of the participants who seroconverted had long-term follow-up with consistent monthly sampling before and after seroconversion, allowing detailed study.
The first indication of HCV infection was the presence of HCV RNA in serum, which preceded elevation of alanine transaminase levels and total bilirubin levels to > or =2 times baseline in 45% and 77% of patients, respectively. No subjects had jaundice. The median time from initial viremia to seroconversion was 36 days (range, 32-46 days). In one instance, viremia was detected 434 days before seroconversion. However, in no other case was HCV RNA detected >63 days before seroconversion. In subjects with viral persistence, a stable level of HCV RNA in the blood was noted in some subjects within 60 days after the initial detection of viremia, but in others, it was not apparent until >1 year later. In subjects with long-term viral clearance, HCV became persistently undetectable as early as 94 and as late as 620 days after initial viremia.
These data underscore the importance of nucleic acid screening of blood donations to prevent HCV transmission and of long-term follow-up to ascertain whether there is viral persistence, at least among injection drug users.
在西方国家，超过三分之二的丙型肝炎病毒（HCV）感染是由注射吸毒引起的，但关于HCV最常见感染方式的前瞻性临床数据很少，部分原因是急性期HCV感染通常无症状。
为了描述急性期HCV感染的特征，对179名HCV抗体阴性的注射吸毒者进行了前瞻性评估；其中62名（34%）患者发生了血清转化。20名发生血清转化的参与者在血清转化前后进行了每月一次的长期随访，以便进行详细研究。
HCV感染的首个迹象是血清中出现HCV RNA，分别有45%和77%的患者在丙氨酸转氨酶水平和总胆红素水平升高至≥基线水平的2倍之前就已出现HCV RNA。没有受试者出现黄疸。从初始病毒血症到血清转化的中位时间为36天（范围为32 - 46天）。在一个病例中，在血清转化前434天检测到病毒血症。然而，在其他病例中，在血清转化前>63天均未检测到HCV RNA。在病毒持续存在的受试者中，一些受试者在首次检测到病毒血症后的60天内血液中HCV RNA水平稳定，但在另一些受试者中，直到>1年后才明显。在长期病毒清除的受试者中，HCV最早在初始病毒血症后94天、最晚在620天持续检测不到。
这些数据强调了对献血进行核酸筛查以预防HCV传播的重要性，以及进行长期随访以确定病毒是否持续存在的重要性，至少在注射吸毒者中是如此。
