From the Guidelines
A patient who has been treated for Hepatitis C can still test positive for Hepatitis C antibodies (anti-HCV) after treatment, as these antibodies can persist for life, regardless of the treatment outcome. The presence of anti-HCV antibodies indicates that the patient has been exposed to the virus at some point, but it does not necessarily mean that they still have an active infection. To determine if the patient has achieved a sustained virologic response (SVR) and is no longer infected, a quantitative nucleic acid test for HCV RNA should be performed, as recommended by the study published in the Journal of Hepatology 1.
If the patient tests positive for HCV RNA, it may indicate that the treatment was not successful, or that they have been reinfected. In this case, the next steps would depend on the patient's individual circumstances, including their medical history, the presence of any underlying liver disease, and their risk factors for reinfection. The patient should undergo a complete evaluation, including liver function tests, to determine the best course of action.
According to the study published in the American Journal of Obstetrics and Gynecology 1, the diagnosis of HCV infection depends on the detection of anti-HCV antibodies and HCV RNA. A positive anti-HCV antibody test result should be followed by a quantitative nucleic acid test for HCV RNA to confirm the presence of an active infection.
In terms of treatment, the study published in the Journal of Hepatology 1 suggests that direct-acting antivirals (DAAs) are effective in treating HCV infection, even in patients with recently acquired infection. The ideal duration of treatment remains unknown, but high SVR rates have been reported with shorter treatment durations, such as 6 or 8 weeks.
- Key points to consider:
- Anti-HCV antibodies can persist for life, regardless of treatment outcome
- Quantitative nucleic acid test for HCV RNA is necessary to confirm SVR
- Treatment outcome depends on individual circumstances, including medical history and risk factors
- DAAs are effective in treating HCV infection, even in patients with recently acquired infection
- Ideal duration of treatment remains unknown, but shorter treatment durations may be effective.
From the Research
Hepatitis A and Hepatitis C Co-Infection
- Patients with hepatitis C are at risk for acquiring hepatitis A due to shared risk factors 2, 3, 4.
- Acute hepatitis A superinfection can cause more severe disease, acute hepatic failure, and higher fatality rates in patients with underlying chronic liver disease, including chronic hepatitis C infection 2, 3, 4.
Vaccination Recommendations
- Vaccination against hepatitis A is recommended for patients with hepatitis C to prevent hepatic superinfections 2, 3, 4.
- Hepatitis A and hepatitis B vaccines are safe and immunogenic in patients with mild-to-moderate hepatitis C or chronic liver disease 2, 3, 4.
- Vaccination should be routinely administered to patients upon diagnosis of HCV infection, as early vaccination is important for optimal response 2, 3, 4.
Treatment and Next Steps
- If a patient with hepatitis C has been treated, their hepatitis A status may still be positive if they have not been vaccinated against hepatitis A 2, 3, 4.
- Next steps would include:
Hepatitis A and B Vaccination
- A combination hepatitis A and B vaccine is available and has been shown to be safe and effective in patients with hepatitis C or other chronic liver disease 2, 6.
- Vaccination rates are low in clinical practice, and public health and educational programs are needed to overcome barriers to facilitate timely implementation of these recommendations 3.