title: Transient reappearance of serum hepatitis C virus RNA observed by real-time PCR during antiviral therapy with peginterferon and ribavirin in patients with HCV genotype 1b.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We evaluated the changes in serum HCV RNA during the combination therapy using a novel method for measurement based on real-time PCR.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu 503-8502, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.forename: Seiki
authors.initials: S
authors.lastname: Kiriyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Tanikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hisanaga
authors.forename: Akira
authors.initials: A
authors.lastname: Kanamori
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.forename: Makiko
authors.initials: M
authors.lastname: Takagi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Takanori
authors.initials: T
authors.lastname: Hosokawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Arakawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujimori
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction / Q000379:methods; D012367:RNA, Viral / Q000097:blood*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D044967:Serum / Q000821:virology
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b