A 35-Year-Old Man Is Found to Have Elevated Alanine Aminotransferase

A 35-year-old man is found to have elevated alanine aminotransferase and aspartate aminotransferase levels.  He has no abdominal pain, nausea, or vomiting.  The patient has used intravenous drugs in the past but denies significant alcohol use.  His past medical history is negative for blood transfusions or excessive acetaminophen use.  Physical examination findings are normal.  Laboratory studies show high titers of IgG directed against the hepatitis C envelope protein.  Which of the following is the most likely reason that these antibodies do not confer effective immunity against the infection?

A) Envelope proteins are lost after recurrent viral replication
B) Envelope proteins are sequestered within hepatocytes
C) Envelope proteins have low immunogenicity
D) Envelope proteins have variations in their antigenic structure
E) The antibodies do not have neutralizing properties

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