Approximately 4 million persons in the United States and probably more than 100 million persons worldwide are infected with HCV. The virus has the unique ability to cause persistent infection in a majority of infected people. The immunological correlates of protection and viral clearance and the pathogenesis of liver injury are yet to be defined, but recent studies suggest the importance of cell-mediated immune responses. Although a large proportion of infected persons become chronic carriers, most have relatively mild disease with slow progression. However, chronic and progressive HCV carries significant morbidity and mortality and is a major cause of cirrhosis, end-stage liver disease, and liver cancer. Development of an effective HCV vaccine is not imminent, but recent advances in technology and basic knowledge of molecular virology and immunology may engender novel approaches to the fundamental problems encountered in vaccine development. Vaccines continue to be pursued, since current therapy for HCV is poorly tolerated and not effective for a substantial number of patients.
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