Sequence variation of the hypervariable region in HCV carriers with normal ALT levels: a comparison with symptomatic carriers.

The clinical significance of the hypervariable region (HVR) in the N-terminus of the E2/NS1 region, which encodes the putative envelope glycoprotein (gp 70) of HCV, has not yet been elucidated. We studied the relation between HVR changes and elevation of the alanine aminotransaminase (ALT) level due to liver cell injury as well as the persistence of HCV infection. Three patients (carrier group) who were HCV RNA positive and had normal ALT levels for as long as five years and three patients with high ALT levels were studied. None of the six patients had a history of treatment. HCV RNA was extracted from serum obtained from each patient in 1990 and 1995. The E2/NS1 region, including HVR-1 and HVR-2, was amplified using the RT-PCR method. PCR products were cloned and nucleotide sequences were determined using the dideoxynucleotide chain termination method. No clear correlation was found between the ALT levels and the number of nucleotide substitutions in HVR-1. The number of nucleotide substitutions in HVR-1 during the five years was greater than in other regions. Furthermore, more nucleotide substitutions occurred in the 1st and 2nd codon positions of HVR-1 than in the control region, even in the carrier group. In conclusion, HVR-1 changes are probably a more important factor in persistent viral infection than liver cell injury.