Occult hepatitis C in peripheral blood mononuclear cells in thrombocytopenic patients after achieving sustained virological response with direct-acting antivirals

Abstract

Background/aim Occult hepatitis C virus infection (OCI) may be present in resolved hepatitis C virus (HCV) after direct-acting antivirals (DAAs). DAAs may improve thrombocytopenia after achieving sustained virological response (SVR), but some patients may be manifested with thrombocytopenia after SVR. The aim of our study was to evaluate the presence of OCI in the peripheral blood mononuclear cells (PBMCs) in thrombocytopenic patients after achieving SVR with DAAs. Patients and methods This cross-sectional study included 32 thrombocytopenic patients who achieved SVR with DAAs and 32 HCV-infected patients who achieved SVR with DAAs without thrombocytopenia as a control group. All patients were investigated for HCV-ribonucleic acid (RNA) in PBMCs, hepatitis C virus core antigen (HCVcAg), platelet autoantibodies, and serum thrombopoietin. Results Among thrombocytopenic, non-thrombocytopenic, and both groups, HCV-RNA in PBMCs were detected in 40.63, 6.25, and 23.44%, respectively, although HCVcAg was detected in 31.25, 3.13, and 17.19%, respectively. The comparisons between thrombocytopenic and non-thrombocytopenic patients regarding HCV-RNA in PBMCs and HCVcAg were statistically significant. Comparisons between thrombocytopenic and non-thrombocytopenic and between positive and negative OCI patients regarding serum thrombopoietin were statistically insignificant. Platelet autoantibodies were detected in 56.25% of thrombocytopenic group. Conclusion Our study is the first to provide insights into the relationship between OCI and thrombocytopenia in patients with chronic HCV after achieving SVR with DAAs. The association between OCI and thrombocytopenia may be explained by autoimmune mechanism.