When someone tests positive for hepatitis C a second time, is it more likely to be a relapse or a reinfection?
Today’s hepatitis C medications offer extremely high cure rates. In fact, the few cases of a previously treated patient later testing positive for hepatitis C has some patients wondering “did I relapse or could I have been reinfected?”
There are six different genotypes of the hepatitis C virus (as well as sub-genotypes). A first step to solving the mystery of relapse vs. reinfection starts with knowing which genotype was the initial infection and which genotype does a patient currently have. If the genotypes are different, it’s clear that a patient was exposed to a new strain of the virus – meaning it’s a reinfection.
In an effort to better understand this complex topic, European researchers examined a group of approximately 3,000 hepatitis C patients and tracked them closely after treatment with direct-acting anti-viral medications (sofosbuvir, either alone or in combination).
Of the patients in this study, only 12 (0.4%) “cured” patients later showed signs of hepatitis C infection. These infections were found 24 weeks after the patients were all previously deemed to have a sustained viral response (e.g., cure). Deep genetic sequencing revealed that of these 12, five of them experienced a disease relapse. The remaining 7 were discovered to have a different type of hepatitis C than the initial infection, meaning that they were reinfected. The researchers conclude that most cases of HCV recurrence are actually due to reinfection and not as a result of a relapse.
The potential for reinfection is why it is important for HCV patients to be educated about how to prevent future exposures to the hepatitis C virus (IV needle sharing, unprotected sex, etc.) after they are successfully treated.
Sarrazin C et al. Late relapse versus hepatitis C virus reinfection in patients with sustained virologic response after sofosbuvir-based therapies. Clin Infect Dis 2017 Jan 1;64:44.
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