No evidence of occult hepatitis C virus (HCV) infection in serum of HCV antibody-positive HCV RNA-negative kidney-transplant patients.
Nicot F, Kamar N, Mariamé B, Rostaing L, Pasquier C, Izopet J.
INSERM, U563, Toulouse, France.
Persistence of hepatitis C virus (HCV) in patients who cleared HCV is still debated. Occult HCV infection is described as the presence of detectable HCV RNA in liver or peripheral blood mononuclear cells (PBMCs) of patients with undetectable plasma HCV-RNA by conventional PCR assays. We have assessed the persistence of HCV in 26 kidney-transplant patients, followed up for 10.5 years (range 2-16), after HCV elimination while on hemodialysis. If HCV really did persist, arising out of the loss of immune control caused by institution of the regimen of immunosuppressive drugs after kidney transplantation, HCV reactivation would have taken place. Their immunosuppression relied on calcineurin inhibitors (100%), and/or steroids (62%), and/or antimetabolites (94%). An induction therapy, given to 22 patients, relied on rabbit antithymocyte globulin (59%) or anti-IL2-receptor blockers (32%). All patients had undetectable HCV RNA as ascertained by several conventional tests. At the last follow-up, no residual HCV RNA was detected in the five liver biopsies, the 26 plasma, and in the 37 nonstimulated and 24 stimulated PBMCs tested with an ultrasensitive RT-PCR assay (detection limit, 2 IU/ml). No biochemical or virologic relapse was seen during follow-up. The absence of HCV relapse in formerly HCV-infected immunocompromised patients suggests the complete eradication of HCV after its elimination while on dialysis.
I found this article interesting as well as encouraging. It addresses the issue of persistent HCV in SVRs that, under immune suppression drugs therapy, might reulst in relapse. In this study no residual virus could be detected in serum, liver tissue or peripheral blood mononuclear cells both non-stimulated and stimulated. So in this study there simply was no detectable virus anywhere.
Thanks Mike; articles like this are always heartening, especially as my doc wrote on a recent referral that my HVC was 'in remission' - (doh, what a psychological let-down after a hard-earned SVR). I didn't notice it until I left the office, but will certainly be debating the issue with him next time I see him!!
Thanks, Mike. I'm encouraged. The concept that there might be something left behind that might pop up under immunosuppressive therapy for rheumatoid arthritis or psoriasis (who knows what's going to happen to us when we are older) is too awful to think about. I hope there will be more studies like this to put occult hepatitis ideas to rest.
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