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Seronegative Chronic Hepatitis C Virus InfectionA Teachable Moment

Educational Objective
To describe the characteristics and appropriate evaluation of patients with seronegative chronic hepatitis C virus (HCV) infection.
1 Credit CME

A 44-year-old woman with HIV/AIDS (CD4 lymphocyte count of 18/μL), parvovirus B19–induced anemia, and years of idiopathic elevated liver enzyme levels was admitted to the hospital with subacute progressive malaise and body aches. On initial evaluation, she was found to have worsening liver enzyme levels (aspartate aminotransferase 10 × upper limit of normal [ULN]; alanine aminotransferase 7 × ULN; alkaline phosphatase within normal limits). At that time, she underwent an extensive workup for liver disease, including viral and autoimmune hepatitis serologic testing, as well as magnetic resonance imaging and biopsy of the liver. Her hepatitis A and C antibodies were nonreactive, she had evidence of seroprotection from prior hepatitis B immunization, her autoimmune laboratory results were negative, the magnetic resonance imaging results did not demonstrate any abnormalities, and the biopsy results demonstrated nonspecific preserved hepatic architecture with periportal lymphocytic inflammation and mild fibrosis. She was discharged with a working diagnosis of hepatitis secondary to antiretroviral toxic effects exacerbated by parvovirus B infection and alcohol use, though she reported only occasional social alcohol intake.

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Article Information

Corresponding Author: Joshua F. Craft, MD, Department of Internal Medicine and Pediatrics, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (jcraft@som.umaryland.edu).

Published Online: September 13, 2021. doi:10.1001/jamainternmed.2021.5182

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Centers for Disease Control and Prevention. Viral hepatitis surveillance report 2018—hepatitis C. Published July 2020. Accessed March 27, 2021. https://www.cdc.gov/hepatitis/statistics/2018surveillance/HepC.htm
2.
Colin  C , Lanoir  D , Touzet  S , Meyaud-Kraemer  L , Bailly  F , Trepo  C ; HEPATITIS Group.  Sensitivity and specificity of third-generation hepatitis C virus antibody detection assays: an analysis of the literature.   J Viral Hepat. 2001;8(2):87-95. doi:10.1046/j.1365-2893.2001.00280.xPubMedGoogle ScholarCrossref
3.
Chamie  G , Bonacini  M , Bangsberg  DR ,  et al.  Factors associated with seronegative chronic hepatitis C virus infection in HIV infection.   Clin Infect Dis. 2007;44(4):577-583. doi:10.1086/511038PubMedGoogle ScholarCrossref
4.
Jadoul  M , Berenguer  MC , Doss  W ,  et al.  Executive summary of the 2018 KDIGO Hepatitis C in CKD Guideline: welcoming advances in evaluation and management.   Kidney Int. 2018;94(4):663-673. doi:10.1016/j.kint.2018.06.011PubMedGoogle ScholarCrossref
5.
Alter  MJ , Margolis  HS , Krawczynski  K ,  et al.  The natural history of community-acquired hepatitis C in the United States. the Sentinel Counties Chronic non-A, non-B Hepatitis Study Team.   N Engl J Med. 1992;327(27):1899-1905. doi:10.1056/NEJM199212313272702PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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