Clinical

Hepatitis C virus replication seen in patients with apparent viral clearance

Last Updated: 2006-11-07 8:45:16 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Hepatitis C virus (HCV) can persist and replicate in the livers of patients who have apparently cleared the virus from their blood after antiviral therapy, according to a report in the November 15th issue of Clinical Infectious Diseases.

Previous studies have identified positive-strand HCV RNA in the hepatic tissue of patients with a sustained treatment response. However, it was unclear if viable HCV, capable of replication, was actually present since negative-strand HCV RNA, the viral replicative intermediate, was not detected.

In the present study, Dr. Vicente Carreno and colleagues, from the Foundation for the Study of Viral Hepatitis in Madrid, Spain, tested for positive- and negative-strand HCV RNA in hepatic tissue taken from 20 patients who had shown no serologic evidence of the virus for 35.4 months on average.

Nineteen of the 20 samples contained positive-strand HCV RNA, the report indicates. Moreover, of these 19 samples, 15 had negative-strand HCV RNA also.

Testing of peripheral blood mononuclear cells revealed positive-strand HCV RNA in 13 of 20 samples. Twelve of the 13 samples also contained negative-strand HCV RNA.

The posttreatment liver biopsy specimens of 15 patients still displayed liver necroinflammation, the findings indicate, and fibrosis remained present in seven patients. However, hepatic damage improved in all but two of the patients.

The findings indicate that "these patients did not experience HCV infection clearance, despite apparent clinical disease resolution," the researchers conclude.

They say the possibility of reactivation should be borne in mind if patients undergo chemotherapy of become immunosuppressed, for example. The team cites a case in which HCV reemerged following prednisone therapy, after 8.5 years of negative test results.

Clin Infect Dis 2006;43:1277-1283.