By Liz Highleyman

Sustained virological response (SVR), or continued undetectable HCV RNA 24 weeks after completion of therapy, is widely considered to be a "cure" for chronic hepatitis C. However, it is unclear whether HCV is truly eradicated, as some studies have shown that the virus may remain in the body at low levels after successful treatment.

As reported in the September 2008 issue of Gastroenterology, French researchers conducted a long-term follow-up study of 344 chronic hepatitis C patients who achieved SVR with interferon-based therapy. Participants were followed for a median of 3.27 years (range 0.50-18 years).

The investigators looked for the presence of residual HCV RNA in blood serum, liver, and peripheral blood mononuclear cells (PBMCs) using transcription-mediated amplification with a sensitivity of < 9.6 IU/mL. In addition, they evaluated liver fibrosis progression in biopsy samples according to the METAVIR scale. A total of 114 patients had post-treatment liver tissue assessments and 156 had PBMC assessments.

Results

• Serum HCV RNA remained undetectable in 1300 total samples.

• None of the patients experienced HCV relapse according to serum measurements.

• HCV RNA was also not detected in any of the 156 PBMC specimens.

• However, HCV RNA was detectable in 2 of 114 liver specimens (1.7%).

• Histological analysis of 126 paired pre- and post-treatment liver biopsy samples (median 0.50 years apart) showed that fibrosis stage improved in 56%, remained stable in 32%, and worsened in 12%.

• Regression of cirrhosis was observed in 9 of 14 patients (64%).

• No cases of decompensated cirrhosis were observed.

• 3 patients developed hepatocellular carcinoma.

"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 researchers concluded.

"The presence of residual HCV RNA was observed only in liver tissue (1.7%)," they added. "This result strongly suggests that SVR may be considered to show eradication of HCV infection."

Université Paris VII, Hôpital Beaujon, Clichy, France; Service de Microbiologie, Hôpital Beaujon, Clichy, France; INSERM U-773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France.

10/14/08

Reference
S Maylin, M Martinot-Peignoux, R Moucari, and others. Eradication of hepatitis C virus in patients successfully treated for chronic hepatitis C. Gastroenterology 135(3): 821-829. September 2008. (Abstract).