NATAP - DDW Liver Conference, San Diego, May 21-24 - Report 8

HCV Not Detected in Liver Tissue When Undetected in Serum

Sharon Barrett, from the Center for Liver Diseases at Mater Hospital in Dublin Ireland, reported that HCV RNA was not detectable in liver biopsies (n=31) from all serum PCR negative patients, and she concluded that these individuals non-infective. This suggests to me that if a person can maintain undetectable HCV RNA in blood than maybe what they call a "cure" is possible. This has been controversial. Some doctors won't use the word cure while others do. I'm not sure I understand what a cure is. But if HCV is not detectable in liver tissue, that's impressive. I suppose there may be some caveats. Although undetectable it may still be there at some low level, and maybe HCV can be found elsewhere in body. Here's the abstract.

INTRAHEPATIC VIRAL RNA STATUS OF SERUM PCR NEGATIVE INDIVIDUALS WITH HISTOLOGICAL EVIDENCE OF HEPATITIS C INFECTION.

The disease status of antibody positive, serum (HCV RNA) PCR negative patients remains unclear. It has been assumed that this status correlates with absence of inflammation in liver biopsy and therefore represents viral clearance. The aim of this study was to determine the true infective status of serum PCR negative patients by investigation of HCV RNA status in liver tissue and to correlate intrahepatic PCR status with histological activity, RIBA-3 status and clinical outcome. Thirty-one antibody positive, serum PCR negative patients were biopsied due to elevated ALTs, strongly positive RIBA-3 tests or symptoms. Histological features were scored using the histological activity index [HAI] of Knodell et al. Viral RNA status was determined on snap frozen liver biopsies using nested PCR amplification with a human albumin control. HCV positive and negative liver biopsies served as controls. Liver histology revealed a median HAI of 2 (range 0-5) with inflammatory activity present in 26, normal histology in 5 and fibrosis in 3/31 patients. Steatosis was noted in 10 patients. Serum ALT activity was normal in 25/31 patients (30 IU/L, range 11-108). Number of RIBA bands positive were: 1 band: 4/31 (12.9%), 2 bands: 13 (41.9%), 3 bands: 9 (29%) and 4 bands: 4 (12.9%). HCV RNA was not detectable in liver biopsies (n=31) from all serum PCR negative patients but was detectable in biopsies from serum PCR positive controls. The albumin control was detectable in 30/31 biopsies indicating minimal RNA degradation. Conclusions: (1) 26/31 serum HCV RNA PCR negative individuals had inflammatory activity (2) The number of RIBA bands positive was not a predictor of inflammatory activity (3) HCV RNA was not detectable by nested PCR in liver biopsies of serum PCR negative individuals, deeming these individuals non-infective. The histological findings of this study most likely represent nonspecific reactive changes not HCV related inflammation.