Clinical significance of discordant positive hepatitis C virus transcription-mediated amplification following end of treatment response.

BACKGROUND: Polymerase chain reaction (PCR) assays are the standard for detecting hepatitis C virus viremia. The transcription-mediated amplification (TMA)-based assay is more sensitive.
METHODS: We retrospectively reviewed the charts of patients with a post-end of treatment (EOT) PCR-/TMA+ result to assess the clinical significance of a positive TMA result after a PCR negative EOT response or sustained viral response (SVR). Patients were divided into Group 1: PCR-/TMA+ after EOT response but during 24 week follow-up (n = 4); and Group 2: PCR-/TMA+ after SVR (n = 11).
RESULTS: All Group 1 patients achieved SVR. No Group 2 patients became PCR positive or had a rise in ALT. The TMA subsequently became negative in 6/7 patients with follow-up evaluation.
CONCLUSIONS: A discordant positive TMA post-EOT response or SVR did not seem to be clinically significant. This finding supports the possibility that patients with SVR have an acquired immune surveillance that prevents low-level viremia from progressing to clinical relapse.