Occult Hepatitis C Virus Infection: A Narrative Review

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Busara Songtanin, Jackeline Flores, Romelia Barba, Jowana Saba, Kenneth Nugent
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引用次数: 0

Abstract

Hepatitis C virus (HCV) infections occur worldwide. Approximately 75% of these acute infections lead to chronic hepatitis C with few symptoms, at least during the initial phase of infection. Occult hepatitis C develops in some infected patients. These infections are defined by the presence of HCV RNA in hepatocytes and peripheral blood mononuclear cells (PBMCs) but not in the serum. Some of these patients have negative tests for anti-HCV antibodies, which make them very difficult to detect. These patients have been identified throughout the world. Occult infections have been found more frequently in patients with hepatitis B infection, HIV infection, cryptogenic liver disease/cirrhosis, renal failure on haemodialysis and lymphoproliferative disorders. These infections have also been identified in blood donors who have negative HCV antibodies. Low-level viral replication in the liver likely contributes to ongoing liver damage and the release of infectious virions that potentially infect adjacent hepatocytes and extrahepatic sites, such as PBMCs. Studies indicate that occult HCV infection may contribute to the pathogenesis of cryptogenic liver disease, steatotic liver disease, cirrhosis and hepatocellular carcinoma and could cause relapses following either a spontaneous clearance of the virus or treatment-induced clearance of the virus. These infections present diagnostic difficulties. This virus is present in the liver; however, that would require a liver biopsy to demonstrate this. It is also present in PBMCs, but these cells are not usually used during routine patient evaluation. The development of quasispecies, which can be identified in PBMCs by specialised labs, helps explain ineffective host defence responses and antiviral drug treatment in some patients. There is no specific therapy for the treatment of this sub-group of HCV-infected patients, and treatment should start with direct-acting antiviral drugs with careful follow-up and serial testing for viral clearance. In summary, patients with occult HCV need more study to determine the role of these infections in the progression of liver disease, to improve diagnostic algorithms and to determine treatment protocols that can eliminate these low-level infections.

隐性丙型肝炎病毒感染:一个叙述性的回顾
丙型肝炎病毒(HCV)感染发生在世界各地。大约75%的这些急性感染导致慢性丙型肝炎,至少在感染的初始阶段几乎没有症状。在一些受感染的患者中出现隐匿性丙型肝炎。这些感染的定义是肝细胞和外周血单核细胞(PBMCs)中存在HCV RNA,但血清中不存在。其中一些患者的抗丙肝病毒抗体检测呈阴性,这使得他们很难被发现。这些病人在世界各地都有发现。隐匿性感染在乙型肝炎感染、艾滋病毒感染、隐源性肝病/肝硬化、血液透析肾功能衰竭和淋巴细胞增生性疾病患者中更为常见。在HCV抗体阴性的献血者中也发现了这些感染。肝脏中低水平的病毒复制可能导致持续的肝损伤和感染性病毒粒子的释放,这些病毒粒子可能感染邻近的肝细胞和肝外部位,如PBMCs。研究表明,隐匿性HCV感染可能有助于隐源性肝病、脂肪变性肝病、肝硬化和肝细胞癌的发病机制,并可能在病毒自发清除或治疗诱导的病毒清除后导致复发。这些感染造成诊断困难。这种病毒存在于肝脏中;然而,这需要肝脏活检来证明。它也存在于pbmc中,但这些细胞通常不用于常规患者评估。准物种的发展可以通过专门的实验室在pbmc中识别,这有助于解释某些患者的宿主防御反应和抗病毒药物治疗无效。目前还没有针对这类hcv感染患者的特异性治疗方法,治疗应该从直接作用的抗病毒药物开始,并进行仔细的随访和一系列的病毒清除检测。总之,隐匿性HCV患者需要更多的研究来确定这些感染在肝病进展中的作用,改进诊断算法并确定可以消除这些低水平感染的治疗方案。
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来源期刊
Journal of Viral Hepatitis
Journal of Viral Hepatitis 医学-病毒学
CiteScore
6.00
自引率
8.00%
发文量
138
审稿时长
1.5 months
期刊介绍: The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.
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