End of treatment RNA-positive/sustained viral response in an individual with acute hepatitis C virus infection treated with direct-acting antivirals

Malespin and colleagues reported that 9% of genotype-1 chronic hepatitis C (CHC) patients receiving different approved sofosbuvir (SOF)based therapies, had detectable viremia at the end of treatment (EOT+) and all EOT+ cases reached sustained virological response (SVR), termed here EOT+/SVR. 1 Hepatitis C virus (HCV) RNA levels were measured by Roche CobasTaqMan version 2.0 (CTM, Roche Molecular Diagnostics, Indianapolis, IN, USA) or Abbott RealTime HCV (ART, Abbott Laboratories, Abbott Park, IL, USA). Malespin and colleagues showed that all EOT+ cases were observed by the more sensitive ART.1 Maasoumy and colleagues provided a detailed HCV RNA kinetic analysis of CHC patients receiving different approved SOF-based therapies, by comparing CTM and ART.2 They showed that the ART assay detected HCV RNA on treatment several weeks longer than CTM, suggesting a slower viral decline with ART compared with CTM. They reported that 20% of genotype-1 CHC patients were EOT+ by ART, 92% of whom achieved SVR. The observation made by Malespin and colleagues and Maasoumy and colleagues1,2 was confirmed by a recent analysis of 417 patients treated with SOF plus ledipasvir (LED), with or without ribavirin, in which 29% of genotype-1 CHC patients were EOT+/SVR by ART.3 To date, the EOT+/SVR pattern has not been reported in patients receiving direct-acting antiviral (DAA) therapy for acute hepatitis C (AHC).