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End of treatment RNA-positive/sustained viral response in an individual with acute HCV infection treated with direct-acting antivirals

Therapeutic Advances in Gastroenterology

May 2017

[Full Text, Pubmed]



Malespin and colleagues reported that 9% of genotype-1 chronic hepatitis C (CHC) patients receiving different approved sofosbuvir (SOF)-based therapies, had detectable viremia at the end of treatment (EOT+) and all EOT+ cases reached sustained virological response (SVR), termed here EOT+/SVR. 


Hepatitis C virus (HCV) RNA levels were measured by Roche CobasTaqMan version 2.0 (CTM, Roche Molecular Diagnostics, Indianapolis, IN, USA) or Abbott RealTime HCV (ART, Abbott Laboratories, Abbott Park, IL, USA). Malespin and colleagues showed that all EOT+ cases were observed by the more sensitive ART. Maasoumy and colleagues provided a detailed HCV RNA kinetic analysis of CHC patients receiving different approved SOF-based therapies, by comparing CTM and ART. They showed that the ART assay detected HCV RNA on treatment several weeks longer than CTM, suggesting a slower viral decline with ART compared with CTM.



We recently described a cohort of 7 patients with genotype-1b AHC who were infected via contaminated saline used to flush intravenous contrast during computerized tomography (CT) scans. A total of four patients were treated for 12 weeks with SOF + LED (n = 3) or 10 weeks with elbasvir + grazopravir (n = 1). HCV RNA measurements were assessed in all patients using ART. In three patients, HCV RNA was below the detection limit by 4 weeks of treatment and remained not detected until EOT and during follow up. In the fourth patient, HCV RNA levels declined sharply from baseline (7.0 log IU/ml) immediately after initiation of SOF+ LED treatment. However virus levels remained detected and the patient was EOT+/SVR.


In conclusion, we observed the EOT+/SVR pattern with the ART assay in a patient treated for AHC with SOF + LED, providing evidence that the phenomenon of EOT+/SVR is not restricted to CHC and that EOT+ by ART does not equal DAA treatment failure in AHC patients.

Shteyer E, Dahari H, Gafanovich I, Dery I, Wolf D, Cotler SJ, Lurie Y

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