Long-term interferon alpha maintenance therapy for chronic hepatitis C infection in a patient with common variable immune deficiency.
A 46-year-old woman with common variable immune deficiency acquired acute non-A, non-B hepatitis from contaminated intravenous gamma globulin in 1983. For 6 years she had fluctuating elevations of her serum aminotransferase levels. In 1990 her serum was documented to be hepatitis C virusribonucleic acid positive by polymerase chain reaction, and her liver biopsy revealed chronic hepatitis with early cirrhosis (Knodell score, 15 points). Hepatitis C virus genotyping indicated that she had been infected with the type 3 genotype. She subsequently underwent treatment with interferon alpha (IFN-alpha) for 1 year and experienced biochemical, virologic, and histologic (Knodell score, 9) suppression. She was continued on maintenance therapy for an additional 7 years, with sustained biochemical and virologic suppression. During the sixth year of therapy, complications of portal hypertension were noted with mild ascites and eventually bleeding esophageal varices. This case report documents a favorable biochemical, virologic, and histologic response to IFN-alpha therapy in this setting; supports the notion that the natural progression of hepatitis C virus infection may be more aggressive in patients with common variable immune deficiency; and, although complications of portal hypertension eventually occurred, the suppressive maintenance IFN therapy may have delayed their onset. The future establishment of the long-term effects of IFN therapy on important clinical outcomes is necessary to understand better its therapeutic benefit in chronic hepatitis C infection.
Willson
R A
RA
Department of Medicine, University of Washington, Seattle, USA.
Fischer
S H
SH
Ochs
H D
HD
D000998:Antiviral Agents / Q000627:therapeutic use*; D017074:Common Variable Immunodeficiency / Q000276:immunology* / Q000628:therapy; D004340:Drug Contamination; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008875:Middle Aged; D011994:Recombinant Proteins; D013997:Time Factors
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins