Elsevier

Journal of Clinical Virology

Volume 72, November 2015, Pages 66-68
Journal of Clinical Virology

Successful treatment of HCV-associated cryoglobulinemia with ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin: A case report

https://doi.org/10.1016/j.jcv.2015.09.003Get rights and content

Highlights

  • The role of direct acting antivirals in the treatment of HCV associated cryoglobulinemia is not established.

  • IFN based combinations have significant limitations such as high rates of side effects and length of therapy.

  • We describe a case of a severe hepatitis C virus-associated cryoglobulinemia effectively treated with an interferon-free combination regimen.

  • Rituximab as a combinational partner in severe or refractory cases should also be evaluated in the future.

Abstract

Cryoglobulinemia is an important extrahepatic manifestation of chronic hepatitis C virus infection. Current treatments are suboptimal, resulting in relapse or refractoriness in 30–40% of patients. Hereby, we describe the case of a 40-year old man with severe hepatitis C virus-associated cryoglobulinemia, effectively treated with an interferon-free combination regimen. The patient was treated for 12 weeks with ombitasvir/paritaprevir/ritonavir, dasabuvir and ribavirin. Rapid clinical and immunological response, i.e., the resolution of symptoms and disappearance of serum cryoglobulins, ensued as early as 4 weeks after initiating direct acting antiviral therapy. Our reported case directs the attention to the possible consequences and importance of new, effective, interferon-free antiviral treatments in devastating lymphoproliferative and immunological manifestations of chronic hepatitis C virus infection.

Section snippets

Why this case is important

Lymphoproliferative diseases, such as cryoglobulinemia and B-cell non-Hodgkin lymphoma (NHL) are important extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. Cryoglobulins can be detected in up to 30% of chronic HCV infected patients but symptomatic illness occurs in only 10–15% of the affected individuals [1]. Complications can range from mild to life-threatening and may affect all major organ systems. Immunosuppressive, chemo-immuno and antiviral therapies have been

Case description

A 40 year old male patient with hereditary factor VIII hemophilia was diagnosed with chronic HCV infection in 2003. PR dual therapy initiated in 2010 was suspended because of IFN intolerance and sudden elevation of transaminases. In 2013 severe polyarthritis began, affecting the shoulders and small joints in the hands and feet, with symmetrically distributed palpable purpura on lower extremities. At the beginning of 2014 gradual onset of abnormal gait and decrease in muscle power in the upper

Other similar and contrasting cases in the literature

To our knowledge, this is the first report of a patient with severe symptomatic MC successfully treated with an IFN-free, anti-HCV DAA combination.

Previous data on DAAs as part of IFN containing combinations are also limited in MC. A study by Saadoun et al. [2] reported high effectivity of PR and telaprevir/boceprevir in the treatment of MC. At treatment week 24, the overall virologic response was 69.6% and the clearance of cryoglobulin was observed only in 22.2% of patients [2]. In another

Discussion

Extrahepatic manifestations of chronic HCV infection, such as MC, represents a significant proportion of the disease burden of HCV [8]. Despite the growing knowledge about the pathogenesis, the availability of several therapeutic options and improvements, complete disease remission in MC is suboptimally achieved. The side effects of PR-based treatments are often serious in patients with MC limiting the use of this combination. Moreover, MC is a negative prognostic factor of virological

Conflict of interest

None.

Funding

Research was funded by Semmelweis University, Budapest, Hungary. Further financial support in form of medications was provided by AbbVie, in the context of Viekira® Early Access Program, Hungary.

Ethical approval

Not appropriate, consent was taken from the patient.

Competing interests

MS has been an investigator in clinical trials supported by Novartis, Bristol–Myers Squibb, Janssen-Cilag, Roche, Boehringer-Ingelheim, Merck Sharp & Dohme and AbbVie Pharmaceuticals. MM has been an investigator in clinical trials supported by Novartis, Bristol–Myers Squibb, Janssen-Cilag, AbbVie, Roche, Boehringer-Ingelheim, and Merck Sharp & Dohme. He has received lectures and consultant fees from Janssen-Cilag, AbbVie, Roche, Boehringer-Ingelheim, Merck Sharp & Dohme, and Gilead. All authors

Acknowledgement

We are indebted to Jessica Brosnahan for providing language help.

References (11)

There are more references available in the full text version of this article.

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