Molecular Study of Occult Hepatitis C Infection among Iranian Hemophilia Patients Treated with Direct-acting Antiviral Agents

A new pathological form of HCV named as occult HCV infection (OCI) has been recently characterized by the presence of HCV RNA in liver biopsy and/or peripheral blood mononuclear cell specimens (PBMCs) and the absence of detectable circulating HCV RNA in plasma samples. In this study, we investigated the presence of HCV RNA in PBMCs and plasma samples of 100 hemophilia patients with negative serum HCV RNA.

One hundred hemophilia participants receiving IFN-free direct-acting antivirals (DAAs) regimens as a treatment of HCV infection participated in this study. PBMCs were separated with Ficoll before RNA extraction. The HCV genotypes of the positive specimens were also analyzed by RT-PCR assay. Finally, data analysis was performed by SPSS software.

Our data revealed that out of 100 hemophilia patients, three (3%, 95% CI: 0.006-0.085) were positive for OCI, showing a significant association between OCI and genotype3/drug regimens (p = 0.0203). There was no significant increase at ALT and AST levels in patients with OCI. Moreover, a genotype difference was observed between plasma and PBMCs samples of 1% (1/100) of patients.

Generally, HCV genotyping in PBMCs along with plasma subtyping before beginning the therapy is vital due to the possibility of OCI detection.