Prevalence, clinical and epidemiological consequences of secondary latent HCV infection after a course of interferon-free therapy

The aim. To evaluate the prevalence of secondary latent HCV infection, as well as the dynamics of hepatic fibrosis and extrahepatic manifestations in patients who achieved HCV RNA aviremia after a course of primary interferon-free therapy.

Material and methods. A retro- and prospective single-center exploratory study was conducted with the participation of 125 patients with chronic HCV infection who underwent in-depth examination and received treatment at a non-governmental medical clinic in St. Petersburg in the period from 2015 to 2024. Changes in clinical and laboratory markers of liver fibrosis and extrahepatic manifestations were evaluated in dynamics. HCV eradication was achieved in the absence of HCV RNA in blood plasma and peripheral blood mononuclear cells (PBMCs).

Results and discussion. The study showed a significant effect of HCV eradication on the regression of fibrotic and dystrophic changes in the liver (63.4% of patients had regression of liver fibrosis; p < 0.05), as well as normalization of biochemical parameters and markers of HCV-associated LGSI syndrome (Low Grade Systemic Inflammation). After HCV eradication, 32% of patients retained the laboratory phenomenon of asymptomatic mixed cryoglobulinemia or a symptom complex of cryoglobulinemic vasculitis. The prevalence of secondary latent HCV infection after a course of treatment with direct antiviral drugs (DAAs) was 4.8%, and its outcomes were recurrence of viremia, spontaneous clearance of HCV RNA, and persistence of HCV RNA in PBMCs. The absence of regression of liver fibrosis, extrahepatic manifestations, and normal liver function can be considered potential predictors of the transformation of the viremic form of chronic HCV infection into a secondary latent HCV infection.

Conclusion. Thus, in patients with chronic HCV infection, along with the systemic positive effect of the course of primary interferon-free therapy and the achievement of HCV RNA aviremia, in some cases (4.8%) there is a lack of immunological (incomplete immunological response) and virological response. The results obtained in patients in the near and long-term follow-up periods are of certain clinical and epidemiological interest, indicate the expediency of optimizing outpatient follow-up to assess the risks and likelihood of developing secondary latent HCV infection after a course of interferon-free therapy, and the need for further multicenter studies.

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