Abstract
The question of whether viruses persist after apparent clearance of infection remains unanswered. Here, we describe a patient with hypogammaglobulinemia whose acute hepatitis C virus (HCV) infection appeared to resolve after receipt of interferon therapy, relapse immediately, and then clear spontaneously--only to relapse after receipt of corticosteroid therapy, and clear again, 8.5 years later. Sequencing indicated that the viruses detected during each relapse were virtually identical, with the hypervariable region 1 of E2 appearing to be monoclonal, which is typical of patients with hypogammaglobulinemia. Nonstructural 5A sequences exhibited quasispecies diversity initially but, after 8.5 years, had become monoclonal. The prolonged period of negativity for HCV RNA followed by relapse suggests that HCV may persist in apparent sustained viral responders.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, P.H.S.
MeSH terms
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Adrenal Cortex Hormones / therapeutic use
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Adult
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Agammaglobulinemia / complications*
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Agammaglobulinemia / virology
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Alanine Transaminase / blood
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Amino Acid Sequence
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Antiviral Agents / pharmacology
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Antiviral Agents / therapeutic use
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Female
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Hepacivirus / isolation & purification*
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Hepatitis C / complications
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Hepatitis C / drug therapy
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Hepatitis C / virology*
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Humans
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Interferons / pharmacology
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Interferons / therapeutic use
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Mutation
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Polymorphism, Genetic
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RNA, Viral / genetics
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RNA, Viral / isolation & purification
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Recurrence
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Sequence Analysis, DNA
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Sequence Homology
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Viral Envelope Proteins / genetics
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Viral Nonstructural Proteins / genetics
Substances
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Adrenal Cortex Hormones
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Antiviral Agents
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RNA, Viral
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Viral Envelope Proteins
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Viral Nonstructural Proteins
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glycoprotein E2, Hepatitis C virus
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Interferons
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Alanine Transaminase
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NS-5 protein, hepatitis C virus