Review Article
A New Twist to a Chronic HCV Infection: Occult Hepatitis C
Box 2
Potential pathogenic pathways to an OCI.
(I) Host defined mechanisms [16, 24, 25, 89, 98]: | (a) a host immune response characterized by a reduced Th-1 and enhanced Th-2 response to HCV, | (b) presence of host IL28B polymorphisms that are associated with a reduced response to IFN, | (c) host resistance to the therapeutic actions of ribavirin, | (d) HCV infection of B cells that manifest an interferon resistant phenotype, | (e) enhanced frequency of posttreatment OCI in cirrhotic individuals. | (II) Viral determined mechanisms [46, 79, 94]: | (a) viral mutations/quasispecies that enable infection of nonhepatic tissues (E2 polymorphisms and others), | (b) presence of viral quasispecies with a reduced replicative potential that are sequestered into nonhepatic tissues | as a means of survival in the presence of “more fit” highly replicative species. |
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