Chronic Hepatitis C and Crohn’s Disease: Nosocomial Infection Treatment with PEG-Interferon plus Ribavirin

Abstract

We describe the case of a patient with a diagnosis of Crohn’s disease and accidental infection during abdominal surgery by hepatitis C virus (HCV) who received combination therapy with pegylated interferon-α2b (1.5 µg/kg weekly) plus ribavirin (10.6 mg/kg daily) for histologically demonstrated chronic hepatitis C. After 48 weeks treatment, serum transaminase levels were normal and viremia (HCV RNA) was negative (end-of-treatment response); 24 weeks later (follow-up period), a sustained virological response was demonstrated. The tolerance to combination antiviral therapy was good, without intestinal symptoms of inflammatory bowel disease recurrence. We conclude that current antiviral therapies with immunomodulatory effects may be helpful and safe for patients with inflammatory bowel disease infected by hepatitis C virus.

Efficacy and Safety of Treatment of Hepatitis C in Patients With Inflammatory Bowel Disease

“…On the other hand, 6 case reports with a favorable IBD outcome while on treatment with IFN-α with or without ribavirin were found on literature review 22, 31–35 . All cases were on IBD maintenance therapy during antiviral treatment and no flares were documented.…”

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

“…In the late 1990s, patients with IBD were considered to be at risk of HCV and HBV infection, probably due to previous surgery or blood transfusions. [1][2][3][4][5] Prevalence of HBV infection Some relatively 'old' studies have reported a significantly higher prevalence of HBV infection in IBD patients than in controls. For example, Biancone et al 2 reported that 11% of IBD patients had antibodies to hepatitis B core protein (anti-HBc), a statistically significantly higher figure than in controls.…”

“…16,117,118 Nevertheless, this recommendation remains controversial, as other authors could not confirm the negative effect of inter-feron-a in patients with CD. 2,4,48,56 Scherzer et al 62 analysed the tolerability of interferon-a plus ribavirin in patients with chronic HCV infection and CD, and concluded that gastrointestinal symptoms may be temporarily exacerbated (6 of the 11 CD patients experienced exacerbation of CD-related symptoms). Nevertheless, increased CD activity is easily managed with short-term medical (glucocorticoid) therapy.…”

Efficacy and safety of antiviral therapy in patients with Crohn's disease and chronic hepatitis C

“…As a result of the over expression of Th‐1‐related proinflammatory cytokines including IFN‐γ and TNF‐α, 37 antiviral HCV treatment with IFN‐alpha may induce CD activity. A few case reports describe IBD flares in patients under IFN‐alpha treatment, 17–22 but others observed no increase in CD activity on treatment with IFN‐alpha with or without ribavirin 23, 25, 26 . One patient was successfully treated with pegylated IFN‐alpha and ribavirin on infliximab treatment 25 .…”

“…Therefore, gastroenterologists are reluctant in treating IBD patients with IFN‐alpha. Only a few case reports of successfully treated IBD/HCV patients have been published, using various older 23, 24 or current standard regimes using pegylated IFN‐alpha and ribavirin 25, 26 …”