Spontaneous Clearance of Chronic HCV Infection: An Unusual Phenomenon

Abstract

Introduction: In acute hepatitis C virus (HCV) infection, only about 25% of patients clear the infection through an immune response. Once chronic HCV infection is established in the remaining 75% of patients, spontaneous clearance of HCV infection is extremely uncommon. We present to you 5 such cases. We describe 5 consecutive patients at the Bronx VA Medical Center that spontaneously cleared chronic HCV infection within the last 10 years. The results are as follows: 3 out of 5 patients were chronically infected with HCV genotype 1. Spontaneous clearance occurred in 3 different scenarios: 1.) Two patients were HIV and HCV-co-infected (HIV infection was suppressed with antiretroviral therapy) and were never treated for hepatitis C. After many years of chronic HCV viremia, they spontaneously became HCV RNA undetectable and remained undetectable for up to 4 years. 2.) Two patients with chronic HCV mono-infection were each treated with antiviral therapy, which resulted in undetectable HCV RNA. After the end of therapy, they relapsed to high-level viremia and high ALT level, but spontaneously cleared HCV RNA to undetectable levels and a normal ALT. However, they relapsed again to high HCV RNA and high ALT. One patient subsequently cleared again and relapsed again. 3.) One HCV-mono-infected patient had received a liver transplant and was on immunosuppressive therapy. He never received HCV antiviral therapy. Two years after the liver transplant, his HCV RNA became undetectable, and it has remained undetectable since 3 years ago. Spontaneous clearance of chronic HCV infection is a very rare phenomenon, but we present 5 subjects in 1 medical center over a span of 10 years that exhibit this rare phenomenon, and in different scenarios: 1.) after relapse from antiviral therapy, 2.) post-liver transplantation, and 3.) in HIV/HCV co-infection.