Interferon-free treatment for patients with chronic hepatitis C and autoimmune liver disease: higher SVR rates with special precautions for deterioration of autoimmune hepatitis

Abstract

BackgroundInterferon-free treatment can achieve higher sustained virological response (SVR) rates, even in patients in whom hepatitis C virus (HCV) could not be eradicated in the interferon treatment era. Immune restoration in the liver is occasionally associated with HCV infection. We examined the safety and effects of interferon-free regimens on HCV patients with autoimmune liver diseases.ResultsAll 7 HCV patients with autoimmune hepatitis (AIH) completed treatment and achieved SVR. Three patients took prednisolone (PSL) at baseline, and 3 did not take PSL during interferon-free treatment. In one HCV patient with AIH and cirrhosis, PSL were not administered at baseline, but she needed to take 40 mg/day PSL at week 8 for liver dysfunction. She also complained back pain and was diagnosed with vasospastic angina by coronary angiography at week 11. However, she completed interferon-free treatment. All 5 HCV patients with primary biliary cholangitis (PBC) completed treatment and achieved SVR. Three of these HCV patients with PBC were treated with UDCA during interferon-free treatment.ConclusionsInterferon-free regimens could result in higher SVR rates in HCV patients with autoimmune liver diseases. As interferon-free treatment for HCV may have an effect on hepatic immunity and activity of the autoimmune liver diseases, careful attention should be paid to unexpected adverse events in their treatments.MethodsTotal 12 patients with HCV and autoimmune liver diseases [7 AIH and PBC], who were treated with interferon-free regimens, were retrospectively analyzed.

Sofosbuvir/Ribavirin therapy for patients experiencing failure of ombitasvir/paritaprevir/ritonavir + ribavirin therapy: Two cases report and review of literature

“…There is a case series study of DAA-based therapy for 12 patients with chronic hepatitis C complicated with autoimmune liver disease[46]. One cirrhotic patient with autoimmune hepatitis developed serum ALT elevation and was obliged to receive prednisolone during the therapy with SOF/LDV.…”

Hepatitis C: A Pharmacological Therapeutic Update

“…Therefore, this treatment is recommended in naïve patients or patients previously treated with interferon regimens, without cirrhosis or with compensated cirrhosis (Child A) and for 1 and 4 viral genotypes [ 26 ]. According to the C-EDGE TN and C-EDGE TE studies, another recommendation is established, since differences were observed in the sustained virologic response (SVR) rate based on the patient’s baseline viremia, it being adequate when it was less than 800,000 IU/mL [ 31 , 32 , 33 , 34 , 35 , 36 ].…”

Autoimmune Hepatitis During Ledipasvir/Sofosbuvir Treatment of Hepatitis C: A Case Report

“…However, some evidence suggests alterations of immune status are DAA induced. Kanda et al treated 5 patients with HCV plus primary biliary cholangitis and 7 patients with HCV‐AIH overlap syndrome and achieved a 100% rate of SVR. Of the 7 patients with HCV‐AIH overlap syndrome, 3 received prednisone at baseline and 3 did not receive prednisone during DAA therapy; in 1 female patient with HCV‐AIH overlap syndrome plus cirrhosis who was treated with LDV/SOF, prednisone was not administered at baseline but was given after 8 weeks of liver chemistry abnormalities.…”

“…Studies of antiviral therapy of HCV, while highlighting the safety and effectiveness of DAA regimens, have also reported sporadic episodes of adverse effects associated with immune dysregulation. (2) We report the case of a woman with chronic hepatitis C and idiopathic thrombocytopenic purpura (ITP) who developed AIH during antiviral therapy with LDV/SOF.…”

“…In 2013, a coformulated oral regimen consisting of a nonstructural protein 5A (NS5A) inhibitor (LDV) and an NS5B nucleotide analog inhibitor (SOF) of the HCV became the standard of care to treat chronic infection with HCV genotypes 1 and 4 in adults and more recently in adolescents. Studies of antiviral therapy of HCV, while highlighting the safety and effectiveness of DAA regimens, have also reported sporadic episodes of adverse effects associated with immune dysregulation . We report the case of a woman with chronic hepatitis C and idiopathic thrombocytopenic purpura (ITP) who developed AIH during antiviral therapy with LDV/SOF.…”