title: Relapse of hepatitis C in a pegylated-interferon-alpha-2b plus ribavirin-treated sustained virological responder.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Aiseikai Yamashina Hospital, Kyoto, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohnishi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohkawara
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Sawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Kanji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Kohichiroh
authors.initials: K
authors.lastname: Yasui
authors.forename: Masahito
authors.initials: M
authors.lastname: Minami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohkawara
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa