New insights into the immunopathogenesis of chronic hepatitis C

Despite the high propensity of hepatitis C virus to establish chronic viral persistence, immune-mediated viral clearance occurs in some patients, fostering hopes that therapeutic induction of specific antiviral immune responses might be able to contribute to viral clearance in chronically infected patients. Indeed, recent clinical trials of therapeutic vaccination have provided clear proof of concept that specific immunotherapy can reduce the viral load in some patients. Further improvement of these strategies will depend on a detailed analysis of the immunopathogenesis of chronic hepatitis C. Recent advances in our understanding of the mechanisms of down-regulation of virus-specific immune responses during chronic infection, including the role of regulatory T cells and inhibitory molecules such as programmed death receptor 1, may open up new avenues for second-generation immunotherapeutic interventions.