Sustained eradication of hepatitis C virus by low-dose long-term interferon therapy in a renal transplant recipient with dual infection with hepatitis B and C viruses: a case report

Ming-Ling Chang,Chau-Ting Yeh,Ping-Chin Lai

doi:10.1186/1752-1947-5-246

Ming-Ling Chang, Chau-Ting Yeh + Show 1 more

Open Access

https://doi.org/10.1186/1752-1947-5-246

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Abstract

IntroductionAccelerated liver function deterioration has been recognized in renal transplant recipients infected with hepatitis C virus (HCV). Although combination therapy with interferon plus ribavirin has been established as the standard treatment for patients with chronic HCV, the high risk of allograft rejection associated with interferon therapy has greatly discouraged the clinical use of this regimen. In Asia, where chronic hepatitis B virus (HBV) is prevalent, dual infection with HBV and HCV poses an even greater challenge for clinical hepatologists.Case presentationIn this article, we report the case of a 51-year-old Taiwanese man with dual infection with HBV and HCV prior to renal transplantation. Low-dose interferon (3 to 6 × 106 U/week) and ribavirin (100 mg/day to 200 mg/day) were prescribed following the reactivation of the man's HCV after renal transplantation. Additionally, lamivudine (100 mg/day) was administered concomitantly to prevent HBV reactivation. His initial serum HCV RNA concentration was 5.2 × 106 copies/mL (genotype 2a). After three and one-half years of antiviral therapy, his HCV was successfully eradicated without any episodes of allograft rejection. His serum HCV RNA remained negative six months after withdrawal from interferon and ribavirin treatment. His serum HBV DNA remained undetectable throughout the course of therapy.ConclusionLow-dose, long-term interferon therapy may achieve sustained eradication of HCV in the renal transplant recipient with dual infection with HBV and HCV.

Highlights

Accelerated liver function deterioration has been recognized in renal transplant recipients infected with hepatitis C virus (HCV)
Besides accelerated deterioration of liver function in chronic HCV infection, HCV-related glomerulopathy [3] and HCV-associated fibrosing cholestatic hepatitis [4] have been documented in renal transplant recipients
We report the case of a renal transplant recipient who had dual infection with hepatitis B virus (HBV) and HCV prior to undergoing transplantation

Summary

Introduction

Chronic hepatitis C virus (HCV) infection may lead to severe sequels such as liver cirrhosis and hepatoma [1]. Over the two years, he was admitted to our hospital 14 times for various reasons, including pulmonary cytomegalovirus infection, urinary fungal infection, lip herpes viral infection, acute allograft rejection, pulmonary tuberculosis, tuberculous cystitis, hyperuricemia and ureter stricture with obstructive nephropathy One year after he underwent renal transplantation, antituberculosis therapy was administered for one year with treatment regimens of isoniazid, rifampin, and ethambutol for three months, followed by isoniazid alone for seven months. Sequential follow-up with liver sonography showed mild parenchymal liver fibrosis with moderate change in fatty liver Negative results of his serum HCV RNA were documented once one year before the end of combination therapy and three times at the end of the combination therapy. His HBV DNA was below the detection limit after the withdrawal of prednisolone therapy (a total of six times over the six years)

Discussion

Conclusions