Long-term outcome of chronic hepatitis C patients with sustained virological response to peginterferon plus ribavirin

AIM: To assess the clinical, biochemical and virological long-term outcome in chronic hepatitis C (CHC) patients with a sustained virological response (SVR) after peginterferon (PEG-IFN) plus ribavirin combination therapy. METHODS: One hundred and fifty three patients with a SVR after treatment with PEG-IFN plus ribavirin were included in a 5-year follow-up study in a single Spanish center, based on standard clinical practice. Clinical anamnesis, biochemical analysis, hepatitis C virus RNA and alpha-fetoprotein measurement, ultrasonography and transient elastography were performed annually. RESULTS: The mean follow-up period of the 153 patients was 76 ± 13 mo after they obtained a SVR. Five patients (3.26%) presented with cirrhosis before treatment and 116 (75.8%) had genotype 1. No patient showed evidence of hepatic decompensation. One patient (0.65%) developed a hepatocellular carcinoma at month 30 after achieving SVR. There were no virological relapses during this follow-up period. Persistently elevated alanine aminotransferase was found in only one patient (0.65%). At the end of the 5-year follow-up, the mean value of transient elastography was 7 ± 4.3 kPa (F1). There were no deaths and no other tumors. CONCLUSION: The long-term outcome of 153 CHC patients with SVR to PEG-IFN plus ribavirin was good. No evidence of a virological relapse was seen. One patient (0.65%) developed a hepatocellular carcinoma.

Occult Hepatitis C Virus Infection:A Review

Occult hepatitis C virus(HCV)infection(OCI),first described in 2004,is defined as the presence of HCV RNA in hepatocytes or peripheral blood mononuclear cells without detectable HCV RNA in the serum.Here,we aimed to review the epidemiology,diagnostic methods,clinical implications and potential man-agement recommendations currently described in the litera-ture,as well as the future directions for investigation of this entity.PubMed and Cochrane databases were searched with combination of the following keywords:"occult","hepatitis C virus",and"occult HCV infection".There are data to support OCI as a potential culprit in cryptogenic liver disease.There are also consistent data demonstrating the existence of OCI in specific populations,such as dialysis,human immunodefi-ciency virus-infected and hepatitis B virus-infected patients,and also in the general population.While the gold standard for diagnosis is liver biopsy,examination of peripheral blood mononuclear cells may be a reliable,safer alternative method of diagnosis.Occult HCV infection is likely associated with liver fibrosis and progression of liver disease.Additional studies are required to determine the infectivity of OCI patients,as well as clarify the natural course and specific clinical implications of OCI.Lastly,studies are needed to determine whether treat-ment of OCI leads to decreased morbidity and/or mortality.