The Facts on HCV Spontaneous Clearance
Many people are surprised to hear that some people do clear (are cured of) HCV, without treatment. It is true and they call it Spontaneous Clearance of Hepatitis C. In fact, research indicates that approximately 25% of adults infected with Hepatitis C spontaneously clear the virus without treatment (though different studies have found rates ranging from about 10% to 50%). Spontaneous clearance rates tend to be higher among women than men (40% vs 19% in the recent meta-analysis). Clearance, if it occurs, usually happens within 4 months, but may take up to 18 months, or possibly even longer according to hepcassoc.org
Spontaneous clearance of is also quite high for those that experience symptoms of acute hepatitis C, defined by Wikepedia as “the first 6 months after infection with HCV. In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.” My sister did have Acute Hepatitis C and her symptoms were not mild and they did lead to diagnosis. Her doctor did NOT tell her that there is an up side to Acute Hepatitis C- the high spontaneous clearance rate. (That is why we created this website to make the ALL the info available to you.)
Acute Hepatitis C is thought to signal a more robust immune response. According to a recent study, “Acute Hepatitis C remains rare, and drug and sexual transmission are predominant... Spontaneous viral clearance occurred in 40% of the 72 patients with Acute Hepatitis C observed for 3 months without treatment… Antiviral treatment is highly effective, 24 weeks of pegylated interferon-alpha alone being a good option.”PMID: 19734798 Another 2009 study states that “Treatment rates were highest when treatment was initiated within 12 weeks of diagnosis. Based on these findings, we would advocate a 12 week period of observation for spontaneous clearance [for those with Acute Hepatitis C] before treatment initiation. If no clearance has occurred by 12 weeks, treatment should be initiated.” PMID: 19674285
Why Do Only Some Experience HCV Spontaneous Clearance?
When I first found out that some people clear HCV spontaneously, I wondered how this could be. With my layman mind I thought the obvious answer would be that it depends on the state of the immune system and the state of the liver. I have also read studies where there was spontaneous clearance of hepatitis C virus after liver transplantation. This is rare but the fact that it can happen seemed to support my theory that the state of the liver can affect a person’s ability to clear the virus. I believe this to be the case with my gut but let’s look at the scientific facts on this.
My scientific mind suggests that there could be even more factors involved in spontaneous clearance of Hep C. In fact, epidemiological, viral and host factors have been associated with the differences in HCV clearance or persistence, and studies have demonstrated that a strong host immune response against HCV favours viral clearance.
Thus, variation in genes involved in the immune response may contribute to the ability to clear the virus.
In a recent genome-wide association study, a single nucleotide polymorphism (rs12979860) 3 kilobases upstream of the IL28B gene, which encodes the type III interferon IFN-lambda3, was shown to associate strongly with more than a twofold difference in response to HCV drug treatment. This study shows “that the C/C genotype strongly enhances resolution of HCV infection among individuals of both European and African ancestry. To our knowledge, this is the strongest and most significant genetic effect associated with natural clearance of HCV, and these results implicate a primary role for IL28B in resolution of HCV infection. “PMID: 19759533
I leave the research scientist to follow up on and continue this type of research to create treatments that are more effective and have less side effects. They are doing a great job and there is always new information on promising drug developments. You can follow the latest research here.
Read more about ways to support your immune system and liver health.
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