Relapse of hepatitis C in a pegylated-interferon-α-2b plus ribavirin-treated sustained virological responder

This is the first documented case of late relapse I have seen.

Hepatology Research
Volume 40 Issue 6, Pages 654 - 660
Published Online: 25 May 2010
© 2010 The Japan Society of Hepatology

Case Report

Hideki Fujii, 1 Yoshito Itoh, 2 Naoki Ohnishi, 1 Masafumi Sakamoto, 1 Tohru Ohkawara, 1 Yoshihiko Sawa, 1 Koichi Nishida, 1 Takeshi Nishimura, 2 Kanji Yamaguchi, 2 Kohichiroh Yasui, 2 Masahito Minami, 2 Takeshi Okanoue, 3 Yasuo Ohkawara 1 and Toshikazu Yoshikawa 2

1 Department of Internal Medicine, Aiseikai Yamashina Hospital, 2 Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, and 3 Division of Gastroenterology, Saiseikai Suita Hospital, Osaka, Japan

Correspondence to Dr Yoshito Itoh, Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyou-ku, Kyoto 602-8566, Japan. Email: yitoh@koto.kpu-m.ac.jp

KEYWORDS

chronic hepatitis C • genotype 2a • sustained virological response • relapse • phylogenetic analyses

ABSTRACT

A 41-year-old woman with chronic hepatitis C was treated with pegylated-interferon (PEG-IFN)-α-2b plus ribavirin for 24 weeks. She had hepatitis C virus (HCV) genotype 2a (1600 KIU/mL), and her liver histology showed mild inflammation and fibrosis. Four weeks after the start of the therapy, she achieved a rapid virological response (RVR) and then a sustained virological response (SVR). Serum alanine aminotransferase (ALT) levels remained within normal ranges and HCV RNA continued to be negative. However, ALT levels flared with the re-emergence of HCV RNA in the serum 1.5 years after discontinuation of therapy. HCV RNA obtained from sera before therapy and after relapse shared a 98.6% homology with the E2 region, and phylogenetic analyses indicated that they were the same HCV strain. These results eliminated the possibility of a re-infection and strongly indicated a late relapse of the disease. Therefore, follow-up is necessary for chronic hepatitis C patients after SVR, even if they respond well to therapy, including RVR.

Received 15 September 2009; revision 23 November 2009; accepted 6 December 2009.

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1872-034X.2010.00641.x About DOI
 
Source