Jaundice at onset signifies a good prognosis in anti-D-associated HCV infection

Introduction: Acute hepatitis presenting with jaundice occurs in less than a quarter of patients infected with the hepatitis C virus (HCV). These patients may be associated with a more benign clinical course than those who are asymptomatic. Objective: To compare and contrast the polymerase chain reaction (PCR) and recombinant immunoblot assay (RIBA) status, serum alanine aminotransferase (ALT) levels and histological scores in age, disease duration and viral load matched HCV anti-D recipients with and without a history of jaundice. Methods: HCV status was confirmed by detecting HCV-RNA by PCR and antibodies to HCV using enzyme-linked immunosorbent assay (ELISA) and RIBA-3. Serum ALT levels were measured in all patients and a liver biopsy was performed in 26/34 patients. All patients were genotyped. Results: Fourteen out of 17 jaundiced patients were PCR negative and only 4/17 had RIBA scores greater than 9, whereas all non-jaundiced patients were PCR positive and all 17 had RIBA scores greater than 9. Thirteen out of 17 jaundiced patients had normal ALT values, 3/17 mildly elevated (41-100) and 1/17 greater than 100; 6/17 non-jaundiced patients had normal ALT levels, 9/17 mildly elevated (41-100) and 2/17 greater than 100; 7/9 jaundiced patients had mild histological scores, 0/9 moderate and 2/9 severe; 5/17 non-jaundiced patients had mild, 9/17 moderate and 3/17 severe histological scores. All 34 patients were of genotype 1b. Conclusion: Patients with jaundice had lower antibody scores, increased PCR negativity, normal serum ALT levels and low/normal histological scores. Jaundice at onset was an indicator of good prognosis.