Department of Internal Medicine, Aiseikai Yamashina Hospital, Kyoto, Japan.
Hepatol Res. 2010 Jun;40(6):654-60. doi: 10.1111/j.1872-034X.2010.00641.x.
A 41-year-old woman with chronic hepatitis C was treated with pegylated-interferon (PEG-IFN)-alpha-2b plus ribavirin for 24 weeks. She had hepatitis C virus (HCV) genotype 2a (1600 KIU/mL), and her liver histology showed mild inflammation and fibrosis. Four weeks after the start of the therapy, she achieved a rapid virological response (RVR) and then a sustained virological response (SVR). Serum alanine aminotransferase (ALT) levels remained within normal ranges and HCV RNA continued to be negative. However, ALT levels flared with the re-emergence of HCV RNA in the serum 1.5 years after discontinuation of therapy. HCV RNA obtained from sera before therapy and after relapse shared a 98.6% homology with the E2 region, and phylogenetic analyses indicated that they were the same HCV strain. These results eliminated the possibility of a re-infection and strongly indicated a late relapse of the disease. Therefore, follow-up is necessary for chronic hepatitis C patients after SVR, even if they respond well to therapy, including RVR.
一名 41 岁女性因慢性丙型肝炎接受聚乙二醇干扰素（PEG-IFN）-α-2b 联合利巴韦林治疗 24 周。她患有丙型肝炎病毒（HCV）基因型 2a（1600 KIU/mL），肝脏组织学显示轻度炎症和纤维化。治疗开始后 4 周，她实现了快速病毒学应答（RVR），随后获得了持续病毒学应答（SVR）。血清丙氨酸氨基转移酶（ALT）水平保持在正常范围内，HCV RNA 持续阴性。然而，在治疗停止 1.5 年后，当血清中 HCV RNA 再次出现时，ALT 水平出现了波动。治疗前和复发后从血清中获得的 HCV RNA 在 E2 区具有 98.6%的同源性，系统进化分析表明它们是同一 HCV 株。这些结果排除了再感染的可能性，并强烈表明疾病出现了晚期复发。因此，即使慢性丙型肝炎患者对治疗有良好的反应，包括 RVR，在 SVR 后仍需要进行随访。
