Journal of Clinical Case Reports

HCV Chronicity: Is True Cure Truly Rare? Long-Term Follow-Up in Two HCV Patients

Abstract

Hyder Q and Haider KH

Background: Serum anti-hepatitis C virus antibody (anti-HCV Ab) has multipronged bedside interpretations. Given the inefficient B-cell response and paucity of T-cell response in HCV infection, we hypothesize that anti-HCV Ab represents persistence of HCVRNA irrespective of HCV polymerase chain reaction (HCVPCR) status.
Case report: We present long-term follow-up of two patients, infected with HCV since nearly 1.5 decade. Case 1: A 35-year old female presented to us in July 2003 with dyspepsia. Anti-HCV Ab was positive. Qualitative PCR for HCV (HCV RT-PCR) was positive in May 2007. HCVPCR is negative since treatment with interferon (IFN) and ribavirin in 2008. HCV RT-PCR is continuously negative for 7 times since 2008. Serum anti-HCV Ab tested negative in 2014 but reappeared in 2017. Post-treatment ALT “flare” was observed twice. Case 2: A 24-year old married female reported to us in April 2004 with elevated ALT. Anti-HCV Ab was positive. HCV RT-PCR tested positive in December 2005. She was successfully treated with IFN and ribavirin in 2006. Re-treatment with sofosbuvir and ribavirin was required for HCV relapse in December 2016. After initial treatment in 2006, HCV RT-PCR has remained negative for 9 times, with normalization of ALT. Anti-HCV Ab is persistently positive. HCV RT-PCR is negative since re-treatment in 2017. Conclusion: Since HCV re-activation may occur in seropositive persons, long-term follow up is recommended after treatment and on incidental detection of anti-HCV Ab.