Successful Treatment for Chronic Hepatitis C-Autoimmune Hepatitis Overlap Syndrome due to Daclatasvir and Asunaprevir

• Published in: Case Reports in Gastroenterology Vol. 11; no. 2; pp. 305 - 311
• Main Authors: Sugiura, Ayumi, Wada, Shuichi, Mori, Hiromitsu, Kimura, Takefumi, Matsuda, Yoshiaki, Tanaka, Naoki, Tanaka, Eiji, Kiyosawa, Kendo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 17.05.2017; Karger Publishers
• Subjects: Antiviral drugs; Autoimmunity; Case reports; Chronic hepatitis C-autoimmune hepatitis overlap syndrome; Direct-acting antivirals; Diseases of the digestive system. Gastroenterology; Gastroenterology; Hepatitis; Hepatitis C; Hepatitis C virus; Histology; Immune system; Immunoglobulins; Infections; Interferon; Internal medicine; Liver; Lymphocytes; Medicine; Patients; RC799-869; Single Case; United States > US; Japan; Autoimmunity; Interferon; Hepatitis C virus; Chronic hepatitis C-autoimmune hepatitis overlap syndrome; Direct-acting antivirals
• ISSN: 1662-0631; 1662-0631
• DOI: 10.1159/000475752

Persistent hepatitis C virus (HCV) infection may induce autoimmune diseases and chronic hepatitis C is sometimes accompanied by autoimmune hepatitis (AIH). However, we are worried about the treatment for chronic hepatitis C-AIH overlap syndrome because interferon-based antiviral therapies may enhance autoimmunity and immunosuppressive corticosteroid administration may promote viral replication. Here, we report a patient having chronic hepatitis C-AIH overlap syndrome treated with the direct-acting antivirals (DAA), daclatasvir and asunaprevir. A 50-year-old man was referred to our hospital because of positive anti-HCV antibody and liver dysfunction at a health checkup. Blood tests showed increased immunoglobulin G (IgG) and a high titer of antinuclear antibody (ANA) in addition to elevated serum alanine aminotransferase (ALT) and HCV-RNA. Infiltration of lymphocytes and plasma cells in Glisson’s capsule and severe interface hepatitis were observed in biopsied specimen, which fulfilled the criteria of AIH. We first started oral corticosteroid administration, and serum ALT levels decreased once but elevated again. We commenced daclatasvir and asunaprevir (60 and 200 mg/day, respectively) and serum HCV-RNA became negative after 6 weeks. Adverse effects were not found during the DAA treatment, and serum ALT, IgG, and ANA were significantly decreased. Corticosteroid could be tapered and stopped, but no recurrence occurred. DAA treatment appears to be effective and safe for the patients with chronic hepatitis C-AIH overlap syndrome.