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Anti‐HCV RIBA/LiaTek reactivity and HCV genotype in EIA‐negative patients with viremia

Individuals infected with hepatitis C virus (HCV) usually produce anti‐HCV antibodies detectable by enzyme immunoassay (EIA); however, in certain viremic cases this antibody does not appear. To investigate whether anti‐HCV in these cases is detectable by Western blot (WB), 38 HCV RNA positive/anti‐HCV EIA‐negative sera were tested by RIBA 3.0 or LiaTek III. The HCV genotypes (INNO‐LiPA) were analyzed to determine whether the variance in these genotypes can be the reason for the late, weak antibody production or its absence. As the control group, 282 EIA‐positive/HCV RNA‐positive patients were examined. A single band reactivity of various intensities by RIBA or LiaTek was observed in 16/38 EIA negative sera. Positive results with NS3 were detected in 4 sera and weak positive (+/−) with core, NS3, and NS5 in 5, 6, and 1 sera, respectively. In 3 cases with anti‐NS3, the seroreversion was observed in follow‐up. The distribution of genotypes in anti‐HCV‐negative versus anti‐HCV‐positive groups was: 1b alone, 50.0% vs. 78.0%; 3a alone, 13.2% vs. 15.6%; and mixed (1b+3a), 36.8% vs. 5.0%, respectively. The follow‐up studies showed that viremia was lost spontaneously in 12/35 patients. In some patients infected with two genotypes, the spontaneous loss of the 3a genotype was observed. The study showed that WB tests are useful for serological confirmation of HCV infection in some EIA negative/HCV RNA‐positive patients but, because seroreversion may occur, sequential sera samples should be tested. No unusual HCV genotype was detected in anti‐HCV‐negative/HCV RNA‐positive cases, but the frequency of mixed infection with the 1b+3a genotypes in this group was found to be higher than that in anti‐HCV‐positive hepatitis patients. J. Med. Virol. 59:451–455, 1999. © 1999 Wiley‐Liss, Inc.