Seronegative Chronic Hepatitis C Virus Infection | Infectious Diseases | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close