Eradication of Hepatitis C Virus in Patients Successfully Treated for Chronic Hepatitis C

Background & Aims: It is unclear whether hepatitis C virus (HCV) is eradicated in patients with chronic hepatitis C who achieved a sustained virologic response (SVR). Methods: In this long-term follow-up study, including chronic hepatitis C patients who achieved SVR after interferon-based therapy, the presence of residual HCV RNA in serum, liver, and peripheral blood mononuclear cells (PBMCs) was assessed, using transcription-mediated amplification (sensitivity, <9.6 IU/mL). The benefit of SVR on liver fibrosis was evaluated using the METAVIR score. Results: A total of 344 patients were followed up for a median duration of 3.27 years (range, 0.50–18 y; interquartile range [IQR], 1.68–5.35 y). A total of 114 patients had a posttreatment liver tissue (median, 0.50 y; range, 0–14 y; IQR, 0–3.5 y) and a total of 156 had one PBMC (median, 3.0 y; range, 0.50–18 y; IQR, 1.25–5.50 y). Serum HCV RNA remained undetectable (1300 samples), indicating that none of the patients had a relapse. HCV RNA was detectable in 2 of 114 (1.7%) liver specimens, and in none of 156 PBMC specimens. Histologic analysis of 126 paired pretreatment and posttreatment liver biopsy specimens (median, 0.50 y; range, 0–14 y; IQR, 0–3.5 y) showed that fibrosis stage was improved in 56%, stable in 32%, deteriorated in 12%. Regression of cirrhosis was observed in 9 of 14 (64%) (95% confidence interval, 39–89) patients. No cirrhosis decompensation was observed, and 3 patients developed hepatocellular carcinoma. Conclusions: In this large cohort of chronic hepatitis C patients, SVR was durable up to 18 years after treatment cessation, in addition to fibrosis stability/improvement (88%) and cirrhosis regression (64%). The presence of residual HCV RNA was observed only in liver tissue (1.7%). This result strongly suggests that SVR may be considered to show eradication of HCV infection.

Abbreviations used in this paper: IQR, interquartile range, PBMC, peripheral blood mononuclear cell, PEG-IFN, pegylated interferon, SVR, sustained virologic response, TMA, transcription-mediated assay