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The prevalence of recurrent viremia was low among patients with hepatitis C who achieved sustained virologic response, data from a recently published study demonstrate.
Among those patients who did experience late recurrent viremia, most had HCV reinfection. (HCV reinfection common in MSM with HIV)
Researchers performed sequencing analyses on 3,004 patients from 11 phase 3 trials of sofosbuvir (Sovaldi, Gilead Sciences) or sofosbuvir and ledipasvir (Harvoni, Gilead). Sulkowski and colleagues defined sustained virologic response as having no detectable HVC RNA 12 weeks after completing treatment; late recurrent viremia was defined as having no HVC RNA 12 weeks after treatment, but a recurrence of HVC at 24 weeks of follow-up. Across all 11 trials, there was a 99.7% concordance between virologic response at 12 and 24 weeks, the researchers wrote.
Twelve patients across all trials had late recurrent viremia, 11 of whom had the same HCV subtype at baseline and at recurrence. Phylogenetic analysis showed that of these 12 patients, seven (58%) of those who achieved HCV eradication later became reinfected with a different strain, according to Sulkowski and colleagues, and five experienced relapse from viruses that continued throughout treatment in the liver or another compartment, but re-emerged after 24 weeks. All five who relapsed were infected with HCV genotype 3a, which researchers said was consistent with a high relapse rate of that genotype. Deep sequencing analysis did not detect any drug resistance variants among the group that relapsed.