Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu 503-8502, Japan.
J Clin Virol. 2010 Mar;47(3):258-62. doi: 10.1016/j.jcv.2009.12.023. Epub 2010 Jan 29.
The "response-guided therapy" based on response of hepatitis C virus (HCV) during antiviral combination therapy with peginterferon and ribavirin is important for patients with HCV genotype 1. However, the sensitivity of previous assays for serum HCV RNA is limited.
We evaluated the changes in serum HCV RNA during the combination therapy using a novel method for measurement based on real-time PCR.
Changes in serum HCV RNA during the combination therapy were reanalyzed using TaqMan PCR assay in 144 patients with chronic HCV genotype 1b infection who underwent the therapy under HCV RNA monitoring with the Amplicor Monitor assay. Treatment duration was elongated from 48 weeks to 72 weeks in 17 patients based on the time when serum HCV RNA became negative.
In 9 of 144 (6.3%) patients, serum HCV RNA transiently appeared again on the TaqMan PCR assay after having previously become negative. At the point of reappearance, the Amplicor Monitor assay gave a negative result in all patients, and no flare of alanine aminotransferase activity was observed. Each of the 9 patients achieved an end-of-treatment response but relapsed after the end of treatment, including 3 patients in whom the treatment duration was elongated to 72 weeks.
Attention should be paid to this phenomenon in the antiviral treatment for patients with HCV infection. The transient reappearance of HCV RNA in the serum indicates a high likelihood of relapse, and is likely to be missed without frequent measurements by a sensitive detection method.
基于聚乙二醇干扰素和利巴韦林抗病毒联合治疗期间丙型肝炎病毒（HCV）的应答，“应答指导治疗”对 HCV 基因型 1 患者非常重要。然而，以前 HCV RNA 血清学检测方法的敏感性有限。
我们使用基于实时 PCR 的新检测方法评估了联合治疗期间血清 HCV RNA 的变化。
在接受 HCV RNA 监测的情况下，用 Amplicor Monitor 检测分析了 144 例慢性 HCV 基因型 1b 感染患者接受联合治疗期间血清 HCV RNA 的变化，这些患者之前曾接受过治疗。根据血清 HCV RNA 转为阴性的时间，17 例患者的治疗时间从 48 周延长至 72 周。
在 144 例患者中，有 9 例（6.3%）患者在之前转为阴性后，血清 HCV RNA 在 TaqMan PCR 检测中再次短暂出现。在再次出现的时点，所有患者的 Amplicor Monitor 检测结果均为阴性，且丙氨酸氨基转移酶（ALT）活性无升高。9 例患者均获得了治疗结束时的应答，但在治疗结束后复发，其中 3 例患者的治疗时间延长至 72 周。
在 HCV 感染患者的抗病毒治疗中应注意这种现象。血清 HCV RNA 的短暂再次出现提示高复发风险，如果不使用敏感的检测方法频繁检测，很可能会被漏诊。
