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Semin Liver Dis 2011; 31(4): 410-419
DOI: 10.1055/s-0031-1297929
© Thieme Medical Publishers

The Conundrum of Relapse in STAT-C Therapy: Does HCV Play the Red Queen or Rip Van Winkle?

Robert Ralston1 , 3 , Ira Jacobson2 , Margaret Scull1
  • 1Laboratory of Virology and Infectious Disease and Center for the Study of Hepatitis C, The Rockefeller University, New York, New York
  • 2Department of Medicine, Division of Gastroenterology and Hepatology, Center for the Study of Hepatitis C, Weill Medical College, New York, New York
  • 3Current address: Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri
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Publication History

Publication Date:
21 December 2011 (online)

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ABSTRACT

New treatments for chronic hepatitis C combining direct-acting antivirals (DAAs) with pegylated interferon and ribavirin (PEG-IFN/RBV) have dramatically increased the number of patients whose viral load declines to undetectable levels early in treatment. Most go on to achieve a sustained virologic response, but some patients who maintain undetectable levels of virus throughout treatment later relapse during follow-up. These data suggest that hepatitis C virus (HCV) genomes may persist in form(s) that are refractory to eradication by DAAs and PEG-IFN/RBV. Here we examine the molecular biology of HCV replication and review the clinical virology of relapse for clues as to how the virus might survive months of antiviral therapy to later reappear when treatment is withdrawn.

KEYWORDS

Hepatitis C virus - direct-acting antivirals - relapse - resistance

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Robert RalstonPh.D. 

Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri

1201 E. Rollins Drive, Columbia, MO 65211

Email: ralstonr@missouri.edu