Researchers from Dublin, Ireland, investigated the natural course of hepatitis C virus (HCV) infection among a cohort of Irish women.
All individuals were infected with the HCV genotype 1b via contaminated anti-D immunoglobulin in 1977.
The team assessed the clinical status of 87 polymerase chain reaction (PCR)-positive and 68 PCR-negative women at diagnosis (1994/95). This was also conducted after 4-5 years of follow-up (21/22 years after inoculation).
Other features investigated included: histological status/progression, psychosocial impact of HCV infection, extrahepatic manifestations, and HLA class II associations.
The most common symptoms reported were fatigue and arthralgia.
Furthermore, 77% of women fell within the clinical range for psychological distress.
A history of icteric hepatitis was reported in 21% of PCR-negative and 3% of PCR-positive women after inoculation.
The mean histological activity index/fibrosis scores of PCR-positive and negative women were 4.1/1.1 and 2.1/0.15 at diagnosis, respectively. These were 4.1/1.0 in 44 PCR-positive women after 5 years of follow-up.
Cirrhosis or hepatocellular carcinoma was not observed.
|77% of women with chronic HCV suffered psychological distress.
The researchers found that the DRB1*01 allele was present in 29% of PCR-negative and 9% of PCR-positive women.
The prevalence rates of mixed cryoglobulinemia, sicca complex and positive thyroid autoantibodies in PCR-positive women were 13%, 8%, and 14%, respectively. For antinuclear antibody, rheumatoid factor, and antimitochondrial antibody the rates were 5%, 4%, and 4%.
Author S Barrett, of the Centre for Liver Diseases, Mater Misericordiae Hospital, Dublin, said on behalf of the group, "A benign course of HCV infection with lack of disease progression was observed in women with chronic HCV, 22 years after inoculation.
"Acute icteric hepatitis and the HLA DRB1*01 allele were associated with viral clearance."
"Despite this favorable outcome, high levels of psychological distress and poor quality of life were present," it was concluded.