Abstract
Interferon (IFN) and ribavirin (RBV) combination therapy was previously the standard of care for treatment of hepatitis C virus (HCV) genotype 2 infection. But, it often induced hemolytic anemia. In 2014, sofosbuvir (SOF) was approved for the treatment of chronic HCV genotype 2 in Japan. SOF/RBV therapy is more effective against genotype 2 than IFN/RBV therapy. We report a case of a 74-year-old woman with chronic HCV genotype 2b infection. She received five treatments including RBV and IFN therapy before SOF was approved and all of them were ineffective. Therapies that included RBV induced severe anemia and led to discontinuation of treatment. With pegylated IFN/RBV therapy, the maximum change in hemoglobin (Hb) from baseline was −3.7 g/dL. However, SOF/RBV therapy was effective and she achieved sustained virologic response (SVR) with a maximum change in Hb from baseline of only −1.2 g/dL. We also found reticulocyte count was very low during treatment in this case and speculate it was one of the reasons that she developed hemolytic anemia with RBV. In conclusion, SOF/RBV therapy is effective and allowed the patient to achieve SVR. An SOF/RBV regimen is safe and effective for patients who have or are at risk of anemia induced by RBV.
Highlights
Chronic hepatitis C virus (HCV) infection is a cause of chronic liver disease and hepatocellular carcinoma [1, 2]
Most patients with HCV infection are treated with interferon-free direct-acting antiviral agents (DAAs)
We report a case of HCV genotype 2 infection in a patient who previously had severe anemia with IFN/RBV combination therapy
Summary
Chronic hepatitis C virus (HCV) infection is a cause of chronic liver disease and hepatocellular carcinoma [1, 2]. Most patients with HCV infection are treated with interferon-free direct-acting antiviral agents (DAAs). Ribavirin (RBV) was commonly used in combination with pegylated interferon (Peg-IFN) for treatment of HCV infection; it often induced severe hemolytic anemia and patients tended to discontinue treatment even with a reduction of RBV dose. It has been reported that clinical risk factors for severe RBV-induced anemia include impaired renal function, older age, high dose per body weight of RBV, and female sex [3]. We report a case of HCV genotype 2 infection in a patient who previously had severe anemia with IFN/RBV combination therapy. Despite a low reticulocyte count, she was able to achieve sustained virologic response (SVR) with the combination of sofosbuvir (SOF) and RBV
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