IgG and IgM core antibodies and viral replication in hepatitis C virus carriers.

We studied IgG and IgM antibodies to hepatitis C virus core protein (anti-HCVcore) in relation to serum virus RNA levels in 71 hepatitis C virus carriers. Viremic levels ranged from 10(4)-10(9) copies/ml and were high in 34 chronic active hepatitis patients compared with 17 asymptomatic carriers and 20 cases of chronic persistent hepatitis (p < 0.01). IgG anti-HCVcore was found in 67/71 (94%), but four asymptomatic carriers with low levels of viremia (10(4)-10(5.5) copies/ml) tested negative. IgM anti-HCVcore was found in patients with high levels of viremia (10(8)-10(9) copies/ml), and one (6%) asymptomatic carrier and nine (26%) chronic active hepatitis patients tested positive. In chronic hepatitis patients, viremic levels were significantly higher in cases positive for IgM anti-HCVcore than in negative ones (p < 0.01). However, no correlation was found between the occurrence of IgM anti-HCVcore and serum aminotransferase levels or the histologic activity index. These findings suggest that although IgG anti-HCVcore is sensitive, low viremic patients can escape this screening, and that the IgM anti-HCVcore is induced in association with high levels of virus replication.