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Autoimmune Hepatitis in Association With Sofosbuvir.

Nancy Gupta1, Roxana Bodin, Sachin Sule

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A case study reports autoimmune hepatitis triggered by sofosbuvir and ribavirin treatment for hepatitis C. This rare complication led to drug-induced autoimmune hepatitis, requiring treatment cessation and prednisolone administration.

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Area of Science:

  • Hepatology
  • Immunology
  • Pharmacology

Background:

  • Hepatitis C (HepC) treatment regimens have evolved, with sofosbuvir and ribavirin combination therapy approved in 2013.
  • Autoimmune hepatitis (AIH) is a chronic liver disease characterized by immune system attack on liver cells.
  • Drug-induced liver injury (DILI) can manifest with diverse clinical and histological presentations.

Purpose of the Study:

  • To report a rare case of autoimmune hepatitis triggered by sofosbuvir and ribavirin therapy in a hepatitis C patient.
  • To investigate the clinical, laboratory, and histological features of this drug-induced autoimmune hepatitis.
  • To highlight a potential, previously unreported adverse event associated with sofosbuvir-based regimens.

Main Methods:

  • A case report of a 65-year-old female patient with genotype 2 hepatitis C.
  • Review of pretreatment and post-treatment liver biopsies, liver function tests (LFTs), and autoimmune markers.
  • Clinical assessment and monitoring of response to treatment cessation and immunosuppressive therapy.

Main Results:

  • Patient developed elevated LFTs, fatigue, and positive autoimmune titers (antinuclear antibody, anti-smooth muscle antibody) during therapy.
  • Repeat liver biopsy revealed features consistent with superimposed autoimmune hepatitis, including interface hepatitis and architectural distortion.
  • Diagnosis of drug-induced autoimmune hepatitis was established, leading to discontinuation of sofosbuvir/ribavirin and initiation of prednisolone.

Conclusions:

  • Sofosbuvir and ribavirin combination therapy can potentially trigger autoimmune hepatitis, a complication not previously reported with sofosbuvir.
  • Prompt recognition and management, including immunosuppression, are crucial for patients developing AIH during antiviral treatment.
  • This case underscores the importance of considering rare immune-mediated adverse events in patients receiving direct-acting antiviral agents for hepatitis C.