HCV clearance may occur without retreatment in patients who relapsed

Even without retreatment, spontaneous clearance of chronic hepatitis C virus (HCV) infection can happen in patients who have relapsed following direct-acting antiviral (DAA) therapy, according to a study.

Most cases of chronic HCV infections can be cured using DAAs, although there is still a small chance of viraemia reappearing after a full course of therapy.

Researchers conducted a case–control study of 1,032 patients to examine the incidence of spontaneous clearance of the infection without retreatment. They collected clinical information at baseline, 12 weeks after treatment, and 6 months after relapse and compared these among spontaneous clearers, patients with persistent relapse, and those who achieved a sustained virologic response to therapy 12 weeks after treatment (SVR12).

In the population, 93 patients had a documented relapse, of whom 12 patients (13 percent) spontaneously cleared HCV within 6 months without additional therapy. Eleven of the spontaneous clearers had low levels of HCV RNA (<4 log IU/mL) and normal levels of alanine aminotransferase at the time of relapse. These levels were comparable to those observed in patients with an SVR12.

Moreover, the magnitude and breadth of HCV-specific T cell responses did not significantly differ between the spontaneous clearance group and the SVR12 group.

In light of the findings, the researchers stressed the importance of confirming viraemia prior to retreatment after the relapse, especially for individuals with low levels of HCV RNA and normal or near-normal levels of alanine aminotransferase after DAA treatment.