Prevalence and effect of occult hepatitis C infection in patients with persistent liver enzyme elevation after achieving 24 weeks of sustained virological response

Abstract

Background Despite achieving sustained virological response (SVR) of chronic hepatitis C infection, some of the treated patients have persistent elevations of transaminases. Occult hepatitis C infection (OCI) could be one of the causes. Aim The aim of this study was to detect OCI in peripheral blood mononuclear cells in patients who achieved 24-week SVR with persistent elevations of transaminases. Methods We included 998 naïve chronic HCV-infected patients who received treatment at our hospital. Patients with elevated liver enzymes after achieving SVR were determined. HCV RNA PCR in peripheral blood mononuclear cells was done for those patients (group 1) and was compared with a group with normal levels of enzymes, which was matched in age and sex (group 2). Results Nine hundred and sixty-five patients achieved SVR (96.69%). Seventy-four (7.7%) patients of them had elevated enzymes. OCI was detected in 14/74 (18.9%) patients of group 1, whereas it was seen in 4/67 (5.9%) in group 2. Cirrhosis, OCI, and obesity were associated with this enzymes elevation (P=0.005, 0.024, and <0.001). By multivariate analysis, none of these three parameters were independently associated with the enzyme elevation. The presence of OCI was not significantly associated with the presence of cirrhosis or obesity. Conclusion OCI is not infrequent in patients with persistent transaminase elevations despite obtaining 24 weeks of SVR. Liver cirrhosis, OCI, and obesity could have synergistic effects and should be considered as important risk factors of this persistent enzyme elevation.

Keywords

• directly acting antiviral
• hepatitis C
• liver diseases
• occult hepatitis C infection