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Descartes before the Horse: I Clone, Therefore I Am: The Hepatitis C Virus in Current Perspective

Harvey J. Alter, MD
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Requests for Reprints: Harvey J. Alter, MD, Chief, Immunology Section, Associate Director for Research, Department of Transfusion Medicine, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C711, Bethesda, MD.

Current Author Address: Dr. Alter: Chief, Immunology Section, Associate Director for Research, Department of Transfusion Medicine, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C711, Bethesda, MD 20892.

Ann Intern Med. 1991;115(8):644-649. doi:10.7326/0003-4819-115-8-644
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▪In an unprecedented approach to viral discovery, the hepatitis C virus (HCV) was cloned before it was established by conventional methods of viral detection or by genomic characterization. Hepatitis C virus is a small (10-kb), single-stranded RNA virus with a genomic organization that places it in the family Flaviviridae. The virus is global in distribution, with a prevalence between 0.3% and 1.5%. The same agent causes parenterally acquired and sporadic non-A, non-B hepatitis. Nonparenteral modes of spread are poorly defined, but low-level sexual transmission is probable. There is a strong association between the presence of antibody to HCV (anti-HCV) and hepatocellular carcinoma; a causal role for HCV is suspected but has not been proved.

Hepatitis C virus accounts for at least 85% of the cases of transfusion-associated hepatitis; an anti-HCV-reactive donor was retrospectively identified in nearly 90% of cases. Among donors confirmed by recombinant immunoblot assay (RIBA) to be anti-HCV positive, 80% to 90% are infectious. Hepatitis C virus RNA can be detected within 1 to 2 weeks of exposure and persists throughout the course of infection. Generally, the presence of anti-HCV cannot be confirmed until 9 to 20 weeks after exposure, creating a window period of seronegativity and potential infectivity. It is anticipated that the anti-HCV assay will reduce the number of cases of transfusion-associated hepatitis by 50% in the United States; a 70% reduction has been documented in Spain.





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