Detection of Occult Hepatitis C Virus Infection in Patients Who Achieved a Sustained Virologic Response to Direct-Acting Antiviral Agents for Recurrent Infection After Liver Transplantation

Abstract

Occult infection with the hepatitis C virus (HCV) is defined as the presence of the HCV genome in either liver tissue or peripheral blood monocytes (PBMCs), despite constant negative results from tests for HCV RNA in serum. We investigated whether patients who maintained a sustained virologic response 12 weeks after therapy (SVR12) with direct-acting antiviral (DAA) agents for recurrent HCV infection following liver transplantation had occult HCV infections. We performed a prospective study of 134 patients with recurrent HCV infection following liver transplantation who were treated with DAAs, with or without ribavirin, from 2014 through 2016 (129 patients achieved an SVR12). In more than 10% of the patients who achieved an SVR12 (n=14), serum levels of aminotransferases did not normalize during or after DAA therapy, or normalized transiently but then increased sharply after DAA therapy. Of these 14 patients, 9 were assessed for occult HCV infection by reverse transcription quantitative PCR. This analysis revealed that 55% of these patients (n=5) had an occult infection, with the detection of negative strand viral genome, indicating viral replication. These findings indicate the presence of occult HCV infection in some patients with abnormal levels of serum aminotransferases in spite of an SVR 12 to DAAs for HCV infection following liver transplantation.

Host genetic factors and clinical parameters influencing the occult hepatitis C virus infection in patients on chronic hemodialysis: Is it still a controversial infection?

“…Elmasry et al . reported that all patients with OCI had unfavorable rs12979860 genotypes, whereas the ones without OCI had favorable IFNL3 rs12979860 CC or CT genotypes . In contrast, Bartolomé et al .…”

Persistently altered liver test results in hepatitis C patients after sustained virological response with direct‐acting antivirals

“…A surprising finding was chronic active inflammation in liver tissue biopsy samples from 4 patients who did not have steatosis and did not respond to corticosteroids. This form of histologically proven post‐SVR chronic active hepatitis has been infrequently reported in the IFN‐free era and has recently been attributed to the post‐transplant setting to occult HCV infection . Three patients were diagnosed with autoimmune hepatitis.…”

Hepatitis B and C virus infection and risk of haematological malignancies

“…A few studies reported OCI in blood donors, in some high‐risk groups (haemophiliac and haemodialysis patients) and subjects with cryptogenic liver disease . A recent study demonstrated OCI in patients who achieved a sustained virological response to IFN‐free antiviral therapy for recurrent infection after liver transplantation . No data are actually available in support of OCI in patients with lymphoma.…”