Abstract
ObjectivesTo assess HCV viremia levels just before, during and one year after anti-HCV seroconversion in people who inject drugs (PWID).MethodsPWID enrolling into a needle exchange program in Malmö, Sweden, 1997–2005 constituted the source population. Sera were obtained at enrolment and at approximately 3–4 monthly intervals afterwards, and were initially tested for anti-HIV, HBsAg/anti-HBc and anti-HCV and thereafter for markers previously negative. Seroconversion to anti-HCV had occurred during the study period in 186 out of 332 seronegative subjects. In these anti-HCV seroconverters, quantitative HCV RNA PCR was retrospectively performed on frozen sera to determine viremia levels in the last anti-HCV negative, the first anti-HCV positive and in one year follow-up samples.ResultsAmong 150 subjects seroconverting to anti-HCV with samples available from all three defined time-points, eight different patterns of viremia were observed. Spontaneous clearance at one year was noted in 48 cases (32%) and was associated with female gender (p = 0.03, CI 0.17–1.00). In 13 cases HCV-RNA was not detected in any study sample. Among 61 subjects with pre-seroconversion viremia, viral load was significantly higher in the pre-seroconversion samples compared to subsequent samples. For the whole group, viral load declined to undetectable levels at seroconversion in 28% of cases (but with recurrent viremia in 15%).ConclusionsDifferent patterns of HCV RNA kinetics were observed among PWID with documented seroconversion to anti-HCV. The frequently observed absence of detectable HCV RNA in the first anti-HCV positive sample (irrespective of subsequent viremia) demonstrates the importance of repeated sampling and RNA testing for determination of the outcome of acute infection.
Highlights
Infection with hepatitis C virus (HCV) is a major health problem; the global prevalence is estimated to have increased from 122 million to 185 million between 1990 and 2005, with regional variations ranging from,1.5% to .3.5% [1]
We reported the incidence of HIV, HBV and HCV among new participants, registered in the needle exchange programs (NEP) from 1997 throughout 2005 [25]
Patterns of HCV viremia Characteristics of patients following each of the eight predefined viremia patterns are shown in figure 1
Summary
Infection with hepatitis C virus (HCV) is a major health problem; the global prevalence is estimated to have increased from 122 million to 185 million between 1990 and 2005, with regional variations ranging from ,1.5% to .3.5% [1]. In most cases (60–85%) HCV infection becomes chronic and a high proportion develops progressive fibrosis [4]. Due to the mild clinical presentation, acute HCV infections are often not diagnosed when they occur. Instead HCV infections are usually detected in persons with unexplained liver enzyme elevations or in subjects participating in targeted screening programs; obviously leading to heterogeneity in case definitions of acute or recent HCV infection [6]. In many cases, the first test leading to a diagnosis of HCV infection is often obtained several years after seroconversion [7]. For PWID, hepatitis C is frequently first detected upon inclusion in needle exchange programs (NEP), in opiate substitution therapy or in prison settings [8,9,10]
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