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Published on: July 31, 2016
Hepatitis C Treatment in Patients With Porphyria Cutanea Tarda
Ashwani K Singal1, Krishna V R Venkata2, Sarat Jampana3
1Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama.
Insights
Hepatitis C virus (HCV) treatment, especially with interferon, can cause porphyria cutanea tarda (PCT) relapse. Direct-acting antivirals (DAA) show promise for treating HCV in PCT patients without causing relapse.
Area of Science:
- Hepatology
- Virology
- Dermatology
Background:
- Hepatitis C virus (HCV) infection is a known risk factor for porphyria cutanea tarda (PCT).
- Limited data exists on managing HCV in PCT patients, particularly with newer treatments.
- Direct-acting antivirals (DAA) have significantly advanced HCV therapy.
Purpose of the Study:
- To review the experience of treating HCV in patients with PCT using both older and newer antiviral regimens.
- To assess the safety and efficacy of HCV treatments concerning PCT activity and relapse.
- To evaluate the potential role of DAAs in HCV patients with PCT.
Main Methods:
- A retrospective chart review of 13 patients with PCT who underwent 22 attempts at HCV treatment.
- Analysis of PCT status before, during, and after HCV therapy.
- Review of treatment regimens, including interferon-based, ribavirin, telaprevir, and DAA therapies.
Main Results:
- PCT relapsed in 6 instances during interferon-based therapies, necessitating treatment interruption in 4 cases.
- Hydroxychloroquine was used prophylactically in 6 instances to prevent PCT recurrence.
- Twelve patients achieved sustained viral response, with 9 on DAA regimens.
- DAA therapy in two active PCT patients led to reduced or normalized plasma porphyrins.
Conclusions:
- Interferon and ribavirin-based HCV treatments may trigger PCT relapses.
- Hydroxychloroquine may help prevent PCT recurrence during HCV therapy.
- DAAs appear safe regarding PCT relapse and may help manage porphyrin levels in HCV-infected patients.
Background:
Hepatitis C virus (HCV) infection is a common susceptibility factor for porphyria cutanea tarda (PCT). Experience on HCV treatment in patients with PCT is limited. Recently, HCV treatment has improved with direct-acting antivirals (DAA). We review our experience on HCV treatment in patients with PCT with older and newer regimens.
Materials And Methods:
A retrospective chart review was conducted. HCV treatment was attempted 22 times in 13 patients with PCT (5 attempts in 1, 2 in 5 and 1 in the other 7 patients).
Results:
Before starting HCV treatment, PCT was in complete remission in 16, partial remission in 2, unknown status in 2 and active in 2 instances. PCT relapsed during therapy 6 times (all interferon-based regimens and 2 including telaprevir), 4 requiring treatment interruption. Treatment was interrupted for reasons other than PCT relapse in 2 patients treated with interferon-based regimens. To prevent PCT recurrence, hydroxychloroquine was continued during HCV therapy 6 times (3 interferon regimens, 2 ribavirin regimens without interferon and 1 DAA alone). Twelve patients achieved sustained viral response, 3 with interferon regimens and 9 with DAA. Two patients with active PCT were treated with DAA, with reduction of plasma porphyrins in 1 and normalization in the other at the end of HCV therapy.
Conclusions:
HCV treatment regimens including interferon or ribavirin may precipitate PCT relapse. Hydroxychloroquine may be useful to prevent such relapses. In this limited experience, DAA were not associated with PCT relapse. Studies are needed to examine DAA as a primary PCT treatment in HCV-infected patients.
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