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Sustained eradication of hepatitis C virus by low-dose long-term interferon therapy in a renal transplant recipient with dual infection with hepatitis B and C viruses: a case report.

Chang ML, Lai PC, Yeh CT - J Med Case Rep (2011)

Bottom Line: Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen.After three and one-half years of antiviral therapy, his HCV was successfully eradicated without any episodes of allograft rejection.His serum HBV DNA remained undetectable throughout the course of therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Liver Cancer Research Center, Chang Gung Memorial Hospital, 6J Laboratory, Linko Medical Center, 199 Tung Hwa North Road, Taipei, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan. chauting@adm.cgmh.org.tw.

ABSTRACT

Introduction: Accelerated liver function deterioration has been recognized in renal transplant recipients infected with hepatitis C virus (HCV). Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen. In Asia, where chronic hepatitis B virus (HBV) is prevalent, dual infection with HBV and HCV poses an even greater challenge for clinical hepatologists.

Case presentation: In this article, we report the case of a 51-year-old Taiwanese man with dual infection with HBV and HCV prior to renal transplantation. Low-dose interferon (3 to 6 × 106 U/week) and ribavirin (100 mg/day to 200 mg/day) were prescribed following the reactivation of the man's HCV after renal transplantation. Additionally, lamivudine (100 mg/day) was administered concomitantly to prevent HBV reactivation. His initial serum HCV RNA concentration was 5.2 × 106 copies/mL (genotype 2a). After three and one-half years of antiviral therapy, his HCV was successfully eradicated without any episodes of allograft rejection. His serum HCV RNA remained negative six months after withdrawal from interferon and ribavirin treatment. His serum HBV DNA remained undetectable throughout the course of therapy.

Conclusion: Low-dose, long-term interferon therapy may achieve sustained eradication of HCV in the renal transplant recipient with dual infection with HBV and HCV.

No MeSH data available.


Related in: MedlinePlus

Clinical course of a renal transplant recipient infected with hepatitis B and C viruses (HBV and HCV, respectively). 1st yr~7th yr, first year to seventh year of main treatment; gray lines and arrows, HCV RNA levels; solid lines and arrows, HBV DNA levels; red bar, tacrolimus; green bar, cyclosporine; solid bar, interferon α-2b; gray bar, ribavirin; empty bar, lamivudine.
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Figure 1: Clinical course of a renal transplant recipient infected with hepatitis B and C viruses (HBV and HCV, respectively). 1st yr~7th yr, first year to seventh year of main treatment; gray lines and arrows, HCV RNA levels; solid lines and arrows, HBV DNA levels; red bar, tacrolimus; green bar, cyclosporine; solid bar, interferon α-2b; gray bar, ribavirin; empty bar, lamivudine.

Mentions: His liver biochemistry tests (aspartate aminotransferase, alanine aminotransferase (ALT) and bilirubin) were normal until three years after renal transplantation, when mild elevated aminotransferase levels about one to threefold the upper limit of normal were noted. Prednisolone was withdrawn at the same time. Marked elevation of aminotransferase levels (up to sevenfold the upper limit of normal) associated with jaundice (bilirubin 3 mg/dL to 4 mg/dL) were found one year after the administration of prednisolone. His HBV DNA was below the detection limit (<300 copies/mL), whereas his HCV RNA was 5.2 × 106 copies/mL. A HCV genotype assay indicated genotype 2a. One year later lamivudine therapy (100 mg/day) was prescribed and was continued for the next two years. Upon the acute exacerbation of liver function, ribavirin monotherapy was given intermittently at 200 mg/day for nine months and 200 mg every other day for the following two months. A liver biopsy was taken one year later, which revealed chronic active hepatitis with a Knodell Histology Activity Index score of 10 (periportal necrosis, 3; intralobular necrosis, 1; portal inflammation, 3; and fibrosis, 3) as well as marked fatty change. The patient's immunohistochemistry study for HBsAg was positive. Combination therapy of ribavirin (200 mg/day or every other day) and interferon α-2b (3 × 106 U by subcutaneous injection once to twice weekly) was started one year after his acute exacerbation of liver function. The doses were adjusted according to the tolerability of the host as well as the blood tests (Figure 1). His combination therapy was ended in four years. His ALT levels fluctuated between 100 U/L and 260 U/L (up to sevenfold the upper limit of normal) during the first two years of his acute liver exacerbation, which decreased gradually thereafter. Ultimately, his ALT levels remained between one- and twofold the upper limit of normal. Sequential follow-up with liver sonography showed mild parenchymal liver fibrosis with moderate change in fatty liver. Negative results of his serum HCV RNA were documented once one year before the end of combination therapy and three times at the end of the combination therapy. His HBV DNA was below the detection limit after the withdrawal of prednisolone therapy (a total of six times over the next six years).


Sustained eradication of hepatitis C virus by low-dose long-term interferon therapy in a renal transplant recipient with dual infection with hepatitis B and C viruses: a case report.

Chang ML, Lai PC, Yeh CT - J Med Case Rep (2011)

Clinical course of a renal transplant recipient infected with hepatitis B and C viruses (HBV and HCV, respectively). 1st yr~7th yr, first year to seventh year of main treatment; gray lines and arrows, HCV RNA levels; solid lines and arrows, HBV DNA levels; red bar, tacrolimus; green bar, cyclosporine; solid bar, interferon α-2b; gray bar, ribavirin; empty bar, lamivudine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141702&req=5

Figure 1: Clinical course of a renal transplant recipient infected with hepatitis B and C viruses (HBV and HCV, respectively). 1st yr~7th yr, first year to seventh year of main treatment; gray lines and arrows, HCV RNA levels; solid lines and arrows, HBV DNA levels; red bar, tacrolimus; green bar, cyclosporine; solid bar, interferon α-2b; gray bar, ribavirin; empty bar, lamivudine.
Mentions: His liver biochemistry tests (aspartate aminotransferase, alanine aminotransferase (ALT) and bilirubin) were normal until three years after renal transplantation, when mild elevated aminotransferase levels about one to threefold the upper limit of normal were noted. Prednisolone was withdrawn at the same time. Marked elevation of aminotransferase levels (up to sevenfold the upper limit of normal) associated with jaundice (bilirubin 3 mg/dL to 4 mg/dL) were found one year after the administration of prednisolone. His HBV DNA was below the detection limit (<300 copies/mL), whereas his HCV RNA was 5.2 × 106 copies/mL. A HCV genotype assay indicated genotype 2a. One year later lamivudine therapy (100 mg/day) was prescribed and was continued for the next two years. Upon the acute exacerbation of liver function, ribavirin monotherapy was given intermittently at 200 mg/day for nine months and 200 mg every other day for the following two months. A liver biopsy was taken one year later, which revealed chronic active hepatitis with a Knodell Histology Activity Index score of 10 (periportal necrosis, 3; intralobular necrosis, 1; portal inflammation, 3; and fibrosis, 3) as well as marked fatty change. The patient's immunohistochemistry study for HBsAg was positive. Combination therapy of ribavirin (200 mg/day or every other day) and interferon α-2b (3 × 106 U by subcutaneous injection once to twice weekly) was started one year after his acute exacerbation of liver function. The doses were adjusted according to the tolerability of the host as well as the blood tests (Figure 1). His combination therapy was ended in four years. His ALT levels fluctuated between 100 U/L and 260 U/L (up to sevenfold the upper limit of normal) during the first two years of his acute liver exacerbation, which decreased gradually thereafter. Ultimately, his ALT levels remained between one- and twofold the upper limit of normal. Sequential follow-up with liver sonography showed mild parenchymal liver fibrosis with moderate change in fatty liver. Negative results of his serum HCV RNA were documented once one year before the end of combination therapy and three times at the end of the combination therapy. His HBV DNA was below the detection limit after the withdrawal of prednisolone therapy (a total of six times over the next six years).

Bottom Line: Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen.After three and one-half years of antiviral therapy, his HCV was successfully eradicated without any episodes of allograft rejection.His serum HBV DNA remained undetectable throughout the course of therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Liver Cancer Research Center, Chang Gung Memorial Hospital, 6J Laboratory, Linko Medical Center, 199 Tung Hwa North Road, Taipei, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Taoyuan, Taiwan. chauting@adm.cgmh.org.tw.

ABSTRACT

Introduction: Accelerated liver function deterioration has been recognized in renal transplant recipients infected with hepatitis C virus (HCV). Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen. In Asia, where chronic hepatitis B virus (HBV) is prevalent, dual infection with HBV and HCV poses an even greater challenge for clinical hepatologists.

Case presentation: In this article, we report the case of a 51-year-old Taiwanese man with dual infection with HBV and HCV prior to renal transplantation. Low-dose interferon (3 to 6 × 106 U/week) and ribavirin (100 mg/day to 200 mg/day) were prescribed following the reactivation of the man's HCV after renal transplantation. Additionally, lamivudine (100 mg/day) was administered concomitantly to prevent HBV reactivation. His initial serum HCV RNA concentration was 5.2 × 106 copies/mL (genotype 2a). After three and one-half years of antiviral therapy, his HCV was successfully eradicated without any episodes of allograft rejection. His serum HCV RNA remained negative six months after withdrawal from interferon and ribavirin treatment. His serum HBV DNA remained undetectable throughout the course of therapy.

Conclusion: Low-dose, long-term interferon therapy may achieve sustained eradication of HCV in the renal transplant recipient with dual infection with HBV and HCV.

No MeSH data available.


Related in: MedlinePlus