Occult HCV may persist in treated patients after liver transplant

By David Douglas

NEW YORK (Reuters Health) - Despite a sustained virologic response for 12 weeks (SVR12) to direct-acting antiviral agents for recurrent hepatitis C virus (HCV) infection following liver transplantation, some patients continue to have occult infection.

That's according to a new study online November 9 in Gastroenterology. As Dr. Takeshi Saito told Reuters Health by email, "We discovered that the HCV RNA blood test, thought to be the standard for guaranteeing viral clearance, may not be enough to detect continued infection."

Co-investigator Dr. Jeffrey A. Kahn added, "Our study confirms the presence of hepatitis C in hepatocytes (liver cells) of some patients who were treated for HCV post-liver transplant with direct-acting antivirals and achieved an SVR 12 (felt to be the standard for cure).

"Further investigation," he pointed out, "will be required to determine the scope and clinical significance of our findings."

For the study, Drs. Saito and Kahn of the University of Southern California, Los Angeles, and colleagues studied 134 such patients with recurrent HCV infection.

All patients were treated with direct-acting antiviral agents, with or without ribavirin, and 129 achieved an SRV12. However, in 14 of this group, serum levels of aminotransferases did not normalize or normalized only briefly after antiviral treatment but then increased sharply.

Nine of these patients underwent liver biopsies and were assessed for occult HCV infection by reverse transcription quantitative PCR. This showed that five had an occult infection via detection of negative strand viral genome, indicating viral replication.

The cause of abnormal aminotransferases in the remaining four patients, say the researchers, "remains elusive."

The findings "urge the utilization of tissue sample-based detection of HCV-genome, at least for those with abnormal aminotransferases," the team adds.

In patients with occult infection and "with sustained abnormal aminotransferases," they conclude, "an additional course of antiviral therapy can be considered to preserve the longevity of the graft."

SOURCE: https://bit.ly/2gOx9f2

Gastroeneterology 2016.