Spontaneous clearance of hepatitis C infection post-liver transplant: A rare but real phenomenon? A case report and review of the literature

Background. We aimed to determine if an association exists between uncomplicated hepatitis C virus (HCV) infection and depression or fatigue.Method. A review of the literature was undertaken.Results. There is an association between HCV infection and either depression or fatigue in certain circumstances – those who are aware they are HCV positive, those with advanced liver disease and those seen in specialist referral centres. All these studies are subject to important biases. There are only a few studies in which knowledge of HCV status and assessment of fatigue or depression is independent. These studies do not suggest an association. There is no association between conventional markers of liver disease and depression or fatigue.Conclusions. Despite anecdotal evidence to the contrary, at the moment there is no evidence that HCV infection per se is associated with fatigue or depression, and there is a suggestion that it is not. The same risk factors that exist for fatigue in other physical illnesses, such as metabolic disorder, mood disorder, demographics and lack of exercise, certainly exist for HCV. Although there are elegant theoretical mechanisms, there is no compelling epidemiological evidence for an additional HCV specific fatigue or depression factor.

Download Full-text

Spontaneous Clearance of Chronic HCV: The Key Ending Left in the Dark

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.134 ◽

2019 ◽

Vol 7 (10) ◽

pp. 1657-1659

Author(s):

Nikola Hristov Mumdzhiev ◽

Daniela Valerieva Radicheva ◽

Mariana Penkova Radicheva ◽

Rumen Valchev Tenev ◽

Zlatina Dimitrova Vasileva

Keyword(s):

Hepatitis C ◽

Hcv Rna ◽

Spontaneous Clearance ◽

Hepatitis C Infection ◽

Positive Serology ◽

Mild Disease ◽

Spontaneous Hcv Clearance ◽

Chronic Hcv ◽

Direct Acting ◽

Special Circumstances

BACKGROUND: Hepatitis C is the second leading cause of liver cirrhosis and hepatocellular carcinoma. Although the discovery of direct-acting agents made the disease curable, HCV elimination can be achieved solely by the host’s immunologic arsenal. CASE REPORT: We report the case of a 29-year-old woman with chronic hepatitis C infection - elevated transaminases, positive serology. HCV was detectable on two occasions, and histology showed mild disease - A1F1. Upon follow up and without any treatment, the patient achieved spontaneous clearance confirmed by two consecutive undetectable HCV RNA tests. Spontaneous HCV clearance rarely occurs – 0.5% per person-year. This is sometimes accompanied by special circumstances like additional disease or medical interventions. Host factors like gender and interleukin-28B polymorphisms have been known to contribute to clearance. Viral factors like HCV RNA levels are also a factor. The characteristics of host-viral interplay – age of acquisition and fibrosis stage – cannot be overlooked. CONCLUSION: All of the abovementioned factors contribute to the complex immunological interaction between virus and host and the result, although rarely can be spontaneous clearance.

Download Full-text