Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

Abstract

Background: Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon 0FN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Objective: The aim of this report was to present the case of a male patient with severe symptomatic thrombocytopenia due to HCV infection. Methods:Thrombocytopenia was treated with pegylated IFN plus ribavirin. Results: Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects. Conclusions: INTRODUCTIONExtrahepatic manifestations of hepatitis C virus (HCV) infection are observed in -38% to 50% of cases~; one of these manifestations is mild to moderate thrombocytopenia. Hepatic disease or cirrhosis with portal hypertension commonly leads to hypersplenism-related thrombocytopenia. Nonetheless, thrombocytopenia is more severe in HCV infections than in other hepatic diseases, possibly because of increased autoimmunity related to HCV infection. In HCV-related thrombocytopenia and idiopathic thrombocytopenic purpura (ITP), large thrombocytes are seen on peripheral smears, and a normal or elevated megakaryocyte count is seen in bone marrow aspirates, indicating peripheral destruction of thrombocytes. Interferons (IFNs) are used in clinical practice for the treatment of HCV infection. 1 Standard IFN monotherapy has been reported in some studies. 1 Although the main effect of IFNs on HCV is the suppression of replication, 1 other beneficial effects include immunomodulation of the host immune system. However, the major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. 2 In addition, few studies have reported improvement in HCV-related thrombocytopenia with IFN therapy, 3 and current guidelines 4 do not mention the treatment of HCV-related thrombocytopenia with IFNs. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.Herein we report a case of HCV-related severe thrombocytopenia treated with IFN alfa-2a, with a fluctuating response. The patient provided written consent to use this material for publication.