The diagnosis of acute hepatitis C virus infection during seroconversion: an important therapeutic opportunity.

A 29-year-old male intravenous drug user of 6 years, with a previous history of affective disorder and deliberate self harm had been under the ongoing care of an addiction team for heroin addiction. His medication had recently been changed from buprenorphine to methadone and routine-screening tests had revealed significant elevation of liver transaminases although he was asymptomatic. Based on his deranged liver function tests (LFTs) he was referred to an acute hospital for further assessment. The only clinical sign elicited at this time was tenderness on palpation of the right hypochondrium. No organomegaly was detectable; this was confirmed by normal abdominal ultrasonography. Elevated liver transaminases, particularly alanine aminotransferase (ALT), were noted (Table 1); these continued to rise over the following few days. The patient admitted to having taken approximately 12 g of paracetamol during a 24 h period 3 weeks previously. Based on the clinical history and LFTs there was a high index of suspicion for acute hepatitis C. Although there was no known exposure to a definite HCV positive contact, this man had a 6-year history of needle-sharing intravenous drug use, had undergone tatooing and had two recent episodes of unprotected sexual intercourse. On the day of presentation to hospital (day 7, Fig. 1) a specimen of blood examined for hepatitis C virus (HCV) screening IgG antibody (Ab) was negative. However, a further specimen taken on day 11 was positive, although a supplementary assay, the recombinant immunoblot assay-3 (RIBA3), was negative. On day 15 another specimen was examined; HCVAb remained positive. At this time, the RIBA-3 had also become positive. Retrospective real-time, quantitative, polymerase chain reaction (PCR) amplification of RNA extracted from all of the specimens referred to above was carried out (Fig. 1). Furthermore, a specimen which had been taken 6 days prior to hospital admission (day 1, Fig. 1), also negative for HCVAb, was included. Of note, PCR positivity 10 days prior to seroconversion was observed in this