Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Pediatrics, Korea Hemophilia Foundation Hospital, Seoul, Korea.
Gut Liver. 2017 Sep 15;11(5):721-727. doi: 10.5009/gnl17209.
BACKGROUND/AIMS: Chronic hepatitis C (CHC) is a major comorbidity in patients with hemophilia.
Patients (n=30) were enrolled between September 2015 and April 2016. Twenty-six patients were genotype 1 (1b, n=21; 1a, n=5) and four patients were genotype 2a/2b. Among 21 patients with genotype 1b, Y93H resistance-associated variants (RAVs) were detected in three patients (14.3%). We evaluated sustained virologic response (SVRs) at 12 weeks, as well as relapse and safety.
Five patients with genotype 1a and three patients with genotype 1b (RAV positive) received ledipasvir/sofosbuvir for 12 weeks. SVR12 rate was 100% (8/8). Eleven patients with genotype 1b were treatment-naïve and received daclatasvir plus asunaprevir for 24 weeks. SVR12 rate was 91% (10/11). One patient experienced viral breakthrough without RAV at 12 weeks. Seven treatment-experienced patients with genotype 1b received daclatasvir plus asunaprevir for 24 weeks. SVR12 rate was 85.7% (6/7). One patient experienced viral breakthrough with RAV (L31M, Y93H) at 12 weeks. Four patients with genotype 2a/2b received sofosbuvir plus ribavirin for 12 weeks. SVR12 rate was 100% (4/4). No serious adverse event-related discontinuations were noted.
New direct acting antiviral treatment achieved high SVRs rates at 12 weeks in CHC patients with hemophilia without serious adverse events.
背景/目的：慢性丙型肝炎（CHC）是血友病患者的主要合并症。
患者（n=30）于 2015 年 9 月至 2016 年 4 月期间入组。26 例患者为基因型 1（1b，n=21；1a，n=5），4 例患者为基因型 2a/2b。在 21 例基因型 1b 患者中，有 3 例（14.3%）检测到 Y93H 耐药相关变异（RAV）。我们评估了 12 周时的持续病毒学应答（SVR）以及复发和安全性。
5 例基因型 1a 和 3 例基因型 1b（RAV 阳性）患者接受了 ledipasvir/sofosbuvir 治疗 12 周。SVR12 率为 100%（8/8）。11 例基因型 1b 患者为初治患者，接受达卡他韦联合asunaprevir 治疗 24 周。SVR12 率为 91%（10/11）。1 例患者在 12 周时发生无 RAV 的病毒突破。7 例基因型 1b 的治疗经验患者接受达卡他韦联合asunaprevir 治疗 24 周。SVR12 率为 85.7%（6/7）。1 例患者在 12 周时发生 RAV（L31M，Y93H）相关的病毒突破。4 例基因型 2a/2b 患者接受 sofosbuvir 联合利巴韦林治疗 12 周。SVR12 率为 100%（4/4）。未观察到与严重不良事件相关的停药。
新型直接作用抗病毒治疗在无严重不良事件的情况下，在血友病合并 CHC 患者中实现了 12 周时的高 SVR 率。
