What is the hidden infection by C virus?

It is a chronic inflammatory disease of the liver that can lead to liver cirrhosis and liver cancer. This infection by the hidden virus C was discovered in 2004 by the Viral Hepatitis Study Foundation, as a result of his research work.

Causes

Up to 30% of patients with cryptogenic hepatitis can be caused by the seronegative hidden infection by hepatitis C virus (HIC). The HIC is characterized by the detection of VCH RNA in the liver in the absence of antibodies and viral RNA (anti-VCH and negative VCH RNA determined by conventional techniques in serum). Cases of HIC worldwide have been reported associated with genotype 1-4 of virus C. Hidden infection due to hepatitis C (HIC) has been detected in risk groups such as patients on dialysis, with hematological diseases, and in relatives of patients diagnosed of HIC.

Portada hepatitis B

In addition, HIC can occur in apparently healthy people, without clinical or biochemical evidence of liver disease. Liver damage caused by HIC varies from minimal changes to cirrhosis and liver cancer, although it is usually a more benign disease than classical chronic C hepatitis. It can be associated with chronic hepatitis B and infection with human immunodeficiency virus, which worsens the prognosis.

Hidden Hepatitis C infection (HIC) has been detected in patients on dialysis, with hematological diseases, and in relatives of patients diagnosed with HIC
Dr. Vicente Carreño

Diagnosis

It can only be diagnosed by analysis of liver enzymes (transaminases) and sophisticated techniques of molecular biology for hepatitis C virus in blood or by liver biopsy. The rest of the causes of liver disease must be ruled out.

The development of more sensitive analytical techniques (immunoassays) for the detection of HCV anti-core antibodies together with the determination of HCV RNA in peripheral blood mononuclear cells and in serum after concentrating the viral particles by ultracentrifugation, allows diagnosis of more than 90 % of patients with occult HCV infection without the need to perform a liver biopsy.

Treatments

The Hepatitis Viral Study Foundation Clinic published a paper administering PegIFN and ribavirin to patients with hidden infection by C virus (HIC). We found that patients with HIC responded to treatment in the same way as patients with chronic hepatitis C (classical). There is no published study administering the new antiviral drugs of hepatitis C to patients with IHC, but theoretically they should respond just like classic chronic hepatitis C. The therapeutic approach in patients with HIC should be the same as with classic chronic hepatitis C (see section on Hepatitis C treatment).

How aggressiveness can be predicted

The degree of inflammation and the liver fibrosis stage can be determined by performing a liver biopsy. Liver ultrasound is also used.

References

  • Castillo I, et al. Occult hepatitis C virus infection in patients in whom the etiology of persistently abnormal results of liver-function tests is unknown. J Infect Dis 2004;189:7-14.
  • Carreño V, et al. Occult hepatitis B virus and hepatitis C virus infections. Rev Med Virol 2008;18:139-57.
  • Carreño V, et al. New perspectives in occult hepatitis C virus infection. World J Gastroenterol 2012;18:2887-94.
  • Carreño V. Seronegative occult hepatitis C virus infection: clinical implications. J Clin Virol 2014;61:315-20.
Hepatólogo en Madrid Dr Vicente Carreño

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Dr. Vicente Carreño
Hepatology specialist

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