Prevalence and predictors of occult hepatitis C virus infection among Egyptian patients who achieved sustained virologic response to sofosbuvir/daclatasvir therapy: a multi-center study
Received 11 September 2018
Accepted for publication 13 December 2018
Published 22 January 2019 Volume 2019:12 Pages 273—279
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Eric Nulens
Mohamed A Mekky,1 Hani I Sayed,2 Mohamed O Abdelmalek,1 Medhat A Saleh,3 Osman A Osman,1 Heba A Osman,4 Khairy H Morsy,5 Helal F Hetta6,7
1Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt; 2Center for Management of Viral Hepatitis, Ministry of Health, Assiut, Egypt; 3Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt; 4Department of Tropical Medicine and Gastroenterology, South Valley University Hospital, Qena, Egypt; 5Department of Tropical Medicine and Gastroenterology, Sohag University Hospital, Sohag, Egypt; 6Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 7Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
Background: Occult hepatitis C virus (HCV) infection (OCI) is characterized by the detection of HCV-RNA in non-serum reservoirs, such as peripheral blood mononuclear cells (PBMCs) and/or hepatocytes with undetectable HCV-RNA or antibodies in the serum. In this study, we tried to evaluate the prevalence and possible predictors of OCI in patients who achieved sustained virologic response (SVR) post sofosbuvir/daclatasvir (SOF/DCV) therapy.
Patients and methods: A cross-sectional multicenter study was designed to enroll 1,280 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks post treatment. They were randomly recruited from three dedicated Egyptian centers for management of HCV. Real-time PCR was performed to detect HCV-RNA in serum and PBMCs and to evaluate the different risk factors pertaining to the existence of OCI.
Results: HCV-RNA was detected in PBMCs of 50 (3.9%) of them. All OCI cases exhibited significant fibrosis score and raised pre-treatment alanine aminotransferase (ALT) levels. Logistic regression analysis comparing OCI with non-OCI revealed that high pre-treatment viral load, raised ALT, advanced fibrosis score, prolonged prothrombin time, low albumin, Child B score, antiviral experienced patients, and raised bilirubin are the most significant predictor for the possibility of OCI presence with Odds Ratio as 7.03, 5.13, 4.4, 2.68, 2.52, 1.9, 1.5, and 1.2, respectively.
Conclusion: In spite of its remote possibility, OCI post SOF/DCV therapy may be present in some cases, and this may entail a re-auditing for the definition of SVR by dual testing in both serum and PBMCs.
Keywords: Occult, hepatitis C, Direct acting, Sofosbuvir
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