S2592 Misleading Hepatitis C Viral Counts During COVID-19 Infection: A Case Report and Discussion

Introduction: COVID-19 infection is associated with liver injury that increases in severity in sicker patients. This is thought to be due to the cytokine storm phenomenon which can paradoxically suppress other underlying chronic viral infections. We report the 1st case of suppressed HCV viral load and undetectable HCV genotype in the setting of COVID-19. Case Description/Methods: A 77-year-old man with chronic hepatitis C (HCV) secondary to intravenous drug use was seen at the gastroenterology clinic for initiation of HCV treatment. Four months prior to presentation, HCV screening showed a positive HCV antibody and HCV viral load of 127330 IU/mL. Further testing for initiation of HCV therapy was remarkable for a markedly decreased HCV viral load of 31 IU/mL. Genotype could not be evaluated as the test requires a viral load of ≥1000 IU/mL. FibroSure revealed F1 fibrosis. Around that time, the patient reported body aches, fevers, and an exposure to a person with upper respiratory tract symptoms. Four days later, he tested positive for COVID-19, then quarantined and recovered. As the marked drop in HCV viral load was felt to be secondary to cytokine response in COVID-19 infection, a decision was made to repeat HCV viral load and genotyping 3 months later. The results revealed a viral load of 9010000 IU/ml and genotype 2b. The patient's liver function tests and INR remained normal and he was initiated on glecaprevir/pibrentasvir. Discussion: While liver injury from cytokine storm in COVID-19 is well recognized, there is paucity of data on its effect on chronic viral infections. This is the first report of documented transient reduction in HCV viral load in COVID-19, presumably secondary to the cytokine response. It is notable that the HCV viral load reduction in this case was to such an extent that genotyping was not possible. Therefore, we believe that reductions to below the lower limit of detection are possible resulting in false negative HCV PCR results. Since it is standard practice to interpret a one-time negative HCV viral load to be indicative spontaneous viral clearance, such a result could lead to a mistaken diagnosis. Clinicians need to be mindful of the coexistent clinical conditions while interpreting HCV PCR results. Additionally, there may be a role for repeating HCV PCR after an interval if a negative result was obtained during a period of widespread community transmission of COVID- 19 or other viral epidemics. Further research is required to validate the appropriateness of such a testing strategy. (Figure Presented).