Hepatitis C late relapse in patients with directly acting antiviral-related sustained virological response at week 12

Area of Science:

• Hepatology
• Virology
• Infectious Diseases

Background:

• Direct-acting antiviral (DAA) regimens have revolutionized Hepatitis C Virus (HCV) treatment.
• Sustained virological response (SVR) is the primary goal of HCV therapy.
• Understanding treatment failure patterns, including late relapse, is crucial for optimizing patient management.

Purpose of the Study:

• To identify patients experiencing late relapse after DAA therapy.
• To characterize the clinical, epidemiological, and virological features of patients with late relapse.
• To evaluate the implications for post-treatment follow-up duration.

Main Methods:

• Enrolled 129 HCV patients who did not respond to an IFN-free regimen.
• Performed Sanger sequencing of NS3, NS5A, and NS5B regions at treatment failure.
• Utilized phylogenetic analysis for available pre-treatment serum samples.

Main Results:

• A late relapse (after 12 weeks post-DAA) occurred in 5.4% (7/129) of patients.
• Phylogenetic analysis suggested reactivation of the initial HCV strain in two late relapse cases.
• Re-infection could not be excluded in five other late relapse cases due to lack of pre-treatment samples.

Conclusions:

• Late relapse after DAA therapy is an infrequent event.
• The findings support the need for extended post-treatment follow-up, potentially up to 72 weeks.
• Further investigation into the mechanisms and implications of late HCV relapse is warranted.