Sunday, July 31, 2016

Spontaneous Clearance of HCV Infection in Patients with Chronic Infection

NEJM Journal Watch

July 28, 2016
Spontaneous Clearance of HCV Infection in Patients with Chronic Infection

Atif Zaman, MD, MPH reviewing Bulteel N et al. J Hepatol 2016 Aug.

Atif Zaman, MD, MPH
Factors associated with this rare event were younger age, female gender, HBV coinfection, and lower HCV RNA level.

Atif Zaman, MD, MPH
The incidence of spontaneous clearance of hepatic C virus (HCV) infection in the acute phase (infected <6 months) is high (estimated at 20%–40%) but is unknown in the chronic phase.

In a population-based case-control study performed in Scotland, investigators assessed spontaneous clearance incidence and its associated risk factors, using HCV testing data from 1994 to 2013. Case patients were defined as those who spontaneously resolved HCV infection and control patients as those who remained chronically infected. All patients had no prior HCV treatment and had ≥2 sequentially positive HCV RNA tests at least 6 months apart, followed by ≥2 negative tests in cases and no negative tests in controls. Four controls were randomly selected for each case.

Among 10,318 patients identified with positive hepatitis B virus (HBV) RNA samples, 50 had documented late spontaneous clearance, for an incidence of 0.36 per 100 person-years of follow-up. Median duration of infection was 50 months in both cases and controls. Spontaneous clearance was significantly associated with younger age at infection (median age, 29 vs. 33 years), female gender, co-infection with HBV infection, and lower HCV RNA level.

These data demonstrate that spontaneous clearance of HCV infection can occur in patients who are chronically infected, albeit at an extremely low rate. Although the exact mechanism of this late spontaneous clearance is unknown, as seen here, certain host and viral factors appear to play a role. On rare occasion, clinicians may see this occur in practice.

Editor Disclosures at Time of Publication
Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

Bulteel N et al. Factors associated with spontaneous clearance of chronic hepatitis C virus infection. J Hepatol 2016 Aug; 65:266. (
Gastroenterology Common Reasons for Hospital Readmissions in Patients with Cirrhosis
Atif Zaman, MD, MPH reviewing Tapper EB et al. Clin Gastroenterol Hepatol 2016 Aug.
Top readmission causes were acute complications of cirrhosis, substance abuse, and cancer complications.

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