Diagnostic challenges from concurrent seronegative HCV and HIV antibody seroreversion in a person living with HIV: A case report

Although Hepatitis C Virus (HCV) infection is typically diagnosed by anti-HCV antibody testing, rare cases of seronegative HCV infection, defined by detectable HCV Ribonucleic Acid (RNA) in the absence of antibodies, have been reported in a small number of Human Immunodeficiency Virus (HIV)-positive patients. We describe the case of an HIV-positive patient with persistently elevated alanine aminotransferase levels who was found to have a high HCV RNA viral load (1,140,000 IU/mL) despite a negative HCV antibody screening. The patient had been receiving combination antiretroviral therapy (cART) initially with efavirenz, TAF and 3TC, and was later switched to bictegravir/TAF/3TC. Following hepatological evaluation and initiation of sofosbuvir/velpatasvir therapy, plasma HCV RNA became undetectable. Remarkably, this patient, who maintained a stable immunological profile, also exhibited spontaneous HIV seroreversion, characterized by the loss of detectable HIV-specific antibodies. These observations illustrate the importance of a molecular-based diagnostic approach to complement serological testing in individuals at risk for HIV-related infections.