Can a patient with Hepatitis C (Hep C) still test positive after treatment?

From the Guidelines

A patient who has been treated for Hepatitis C can still test positive for the virus in some cases, but this is rare, with a cure rate of more than 99% as shown by long-term follow-up studies 1. After completing a full course of direct-acting antiviral (DAA) therapy, most patients achieve sustained virologic response (SVR), meaning the virus is no longer detectable. The endpoint of therapy is an SVR, defined by undetectable HCV RNA in blood 12 weeks (SVR12) or 24 weeks (SVR24) after the end of therapy, as assessed by a sensitive molecular method with a lower limit of detection 1. Some key points to consider in the treatment of Hepatitis C include:

• The goal of therapy is to cure HCV infection in order to prevent the complications of HCV-related liver and extrahepatic diseases 1
• Undetectable HCV core antigen 12 or 24 weeks after the end of therapy can be used as an alternative to HCV RNA testing to assess the SVR12 or the SVR24, respectively, in patients with detectable core antigen before treatment 1
• If a patient still tests positive after treatment, the next steps include testing for viral load to confirm active infection, checking for treatment adherence issues, and consulting with a hepatologist or infectious disease specialist.
• The specialist will likely recommend resistance testing to identify any viral mutations that might have caused treatment failure, then prescribe a different DAA regimen tailored to the specific resistance pattern [based on general medical knowledge and not directly stated in (1)]. The key takeaway is that while treatment failure can occur, it is relatively rare, and most patients can achieve a cure with the right treatment approach 1.

From the Research

Treatment Outcomes for Hepatitis C Patients

• The treatment of Hepatitis C with ledipasvir and sofosbuvir has been shown to be highly effective, with sustained virologic response rates (SVR) of 95-98% in various studies 2, 3, 4.
• The addition of ribavirin to the treatment regimen may improve outcomes in certain patient populations, such as those with cirrhosis or prior treatment failure 5, 4.
• Factors associated with successful treatment outcomes include higher albumin levels, lower total bilirubin levels, and absence of cirrhosis or proton pump inhibitor use 2, 4.

Next Steps for Patients with Hepatitis C

• Patients who have failed prior treatment with daclatasvir and asunaprevir may be retreated with ledipasvir and sofosbuvir, with or without ribavirin, with high rates of success 5.
• Treatment-experienced patients with genotype 1 HCV infection and cirrhosis may be treated with ledipasvir and sofosbuvir, with or without ribavirin, for 12 or 24 weeks, with high rates of SVR 4.
• The choice of treatment regimen and duration should be individualized based on patient characteristics, such as the presence of cirrhosis, prior treatment history, and other medical conditions 4.

Efficacy of Different Treatment Regimens

• Ledipasvir and sofosbuvir, with or without ribavirin, have been shown to be effective in treating patients with HCV genotype 1 infection, with SVR rates of 93-98% 2, 4.
• Daclatasvir and sofosbuvir have also been shown to be effective in treating patients with HCV genotype 4 infection, with SVR rates of 96-98% 3.
• The efficacy of these treatment regimens may vary depending on patient characteristics, such as the presence of cirrhosis or prior treatment failure 5, 4.