Murata Masayuki, Furusyo Norihiro, Ogawa Eiichi, Mitsumoto Fujiko, Hiramine Satoshi, Ikezaki Hiroaki, Takayama Koji, Shimizu Motohiro, Toyoda Kazuhiro, Kainuma Mosaburo, Hayashi Jun
Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
J Infect Chemother. 2014 May;20(5):320-4. doi: 10.1016/j.jiac.2013.11.006. Epub 2014 Jan 27.
In Japan, the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection of some patients with hemophilia was caused by the transfusion of imported blood products, such as unheated coagulation factor. With the development of antiretroviral therapy (ART) for HIV, chronic HCV infection has become a major cause of liver disease and mortality for hemophiliac patients coinfected with HCV/HIV. Data is limited regarding the efficacy and safety of antiviral therapy with the HCV protease inhibitor telaprevir (TVR) in combination with pegylated interferon-α (PegIFN-α) and ribavirin (RBV) for hemophilia patients coinfected with HCV/HIV. We report a case of a Japanese patient with hemophilia and HCV/HIV coinfection who had partial response to prior to PegIFN-α and RBV therapy. This is the first published report of 24-week TVR-based triple therapy for a hemophilia patient coinfected with HCV/HIV. The patient had HCV genotype 1a infection with a high viral load. His single-nucleotide polymorphism of the interleukin 28B (rs8099917) gene was the TT major allele. He presented with undetectable HIV RNA and a high CD4(+) T cell counts by taking ART including tenofovir, emtricitabine and raltegravir. He was again treated for HCV with TVR plus PegIFN-α2b and RBV for the first 12 weeks, followed by the continuation of PegIFN-α2b and RBV for 12 additional weeks while continuing ART. He had rapid virological response and achieved sustained virological response with the 24-week treatment. No serious adverse events such as skin rash, severe anemia or exacerbated bleeding tendency were observed, only a mild headache. No dose adjustment was necessary when tenofovir and raltegravir were used in combined with TVR, and no HIV breakthrough was observed. TVR-based triple therapy with ART could can an effective treatment for hemophilia patients coinfected with HCV (genotype 1)/HIV regardless of prior response. TVR can be used in combination with tenofovir, emtricitabine and raltegravir for patients with hemophilia. Furthermore, patients with undetectable HCV RNA at week 4 could be successfully treated with a 24-week regimen.
在日本，一些血友病患者的人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）合并感染是由输入未加热的凝血因子等进口血液制品引起的。随着HIV抗逆转录病毒疗法（ART）的发展，慢性HCV感染已成为HCV/HIV合并感染的血友病患者肝病和死亡的主要原因。关于HCV蛋白酶抑制剂特拉匹韦（TVR）联合聚乙二醇化干扰素-α（PegIFN-α）和利巴韦林（RBV）用于HCV/HIV合并感染的血友病患者的抗病毒治疗的疗效和安全性的数据有限。我们报告了一例日本血友病患者合并HCV/HIV感染，其在接受PegIFN-α和RBV治疗之前有部分反应。这是关于以TVR为基础的三联疗法治疗HCV/HIV合并感染的血友病患者24周的首次发表报告。该患者感染HCV 1a基因型且病毒载量高。他的白细胞介素28B（rs8099917）基因的单核苷酸多态性为TT主要等位基因。通过服用包括替诺福韦、恩曲他滨和拉替拉韦的ART，他的HIV RNA检测不到且CD4(+) T细胞计数高。他再次接受HCV治疗，前12周采用TVR加PegIFN-α2b和RBV，随后在继续ART的同时继续使用PegIFN-α2b和RBV 12周。他有快速病毒学反应，并在24周治疗后实现了持续病毒学反应。未观察到皮疹、严重贫血或出血倾向加重等严重不良事件，仅出现轻度头痛。当替诺福韦和拉替拉韦与TVR联合使用时无需调整剂量，也未观察到HIV突破。基于TVR的三联疗法联合ART对于HCV（1基因型）/HIV合并感染的血友病患者是一种有效的治疗方法，无论其先前的反应如何。TVR可与替诺福韦、恩曲他滨和拉替拉韦联合用于血友病患者。此外，在第4周时HCV RNA检测不到的患者可以通过24周疗程成功治疗。
