Liver Disease with Undetectable HCV RNA

People infected with HCV (as indicated by antibodies in the blood) who have an undetectable viral load are usually considered to have inactive disease, and undetectable HCV RNA six months after completion of treatment is regarded as a cure. But a study in the December 2008 Hepatology suggests hidden HCV may still cause liver disease progression. M. Hoare and colleagues studied 172 HCV antibody positive but HCV RNA negative individuals who underwent liver biopsies between 1992 and 2000. After 102 were excluded for having other possible causes of liver damage, the remaining 70 participants were analyzed after a median seven years of follow-up.

Within this group, 5.7% became HCV RNA positive during follow-up, but the rest had continued undetectable viral load. Only five participants had normal liver biopsies; 82% had some fibrosis, with 24% having moderate to advanced fibrosis (Ishak stage 2-3). HCV RNA negative individuals had fewer CD4 T-cells and more CD8 T-cells than uninfected control subjects, but the same number as patients with detectable viral load. These findings suggest that HCV antibody positive people with undetectable HCV RNA have an ongoing immune response in the liver, supporting the view that the virus may persist in the liver in a majority of these cases.