Hepatitis C treatment with triple therapy in a patient with hemophilia A

Abstract

We report a case of successful treatment of chronic hepatitis C infection with telaprevir-based triple therapy in a patient with hemophilia A complicated by factor VIII inhibitor. A twenty-two years old male with hereditary hemophilia A and high-titer factor VIII inhibitor was taking maintenance doses of recombinant factor VIII. He visited our clinic for treatment of his chronic hepatitis C with the newly instituted protease inhibitor based therapy. He was diagnosed with hepatitis C genotype 1a at one year of age. He was initiated on telaprevir, ribavirin and peg-interferon for treatment of hepatitis C and qualified for response-guided therapy. He completed treatment at 24 wk with minimal adverse effects. Notably, after 4 wk of hepatitis C treatment, his factor VIII inhibitor screen was negative and the dose for recombinant factor VIII decreased by half of the initial dosing before he was treated for hepatitis C. We suspect that suppressing hepatitis C may help decrease factor VIII inhibitor level and the need for recombinant factor VIII.

Keywords: Hepatitis C virus, Hemophilia, Factor VIII, Telaprevir, Factor VIII inhibitor, Protease inhibitor

Core tip: This is a case of a patient who has Hemophilia A with factor VIII inhibitor and chronic hepatitis C. After successfully treating the patient’s hepatitis C with protease-inhibitor based triple therapy and achieving response-guided therapy with negative hepatitis C virus RNA after week 4, the patient’s need for recombinant factor VIII decreased significantly.