title: Combined alpha interferon and ribavirin for the treatment of hepatitis C in patients with hereditary bleeding disorders.
abstract: Patients with hereditary bleeding disorders who received non-virally inactivated plasma-derived clotting factor concentrates before the mid-1980s invariably became infected with hepatitis C virus (HCV). Therapy with interferon alpha (IFN-alpha) alone has been disappointing in this group. We conducted an open-label study, using a combination of IFN-alpha2b (3 million units three times per week) and ribavirin 1-1.2 g/d in 28 patients with hereditary bleeding disorders. Twenty-one of the 28 patients had liver biopsy-confirmed chronic hepatitis (median histological activity index 5; range 1-10) and all patients were HCV RNA positive by PCR. Virological response rate to therapy at 3 months was 82% (23 out of 28). Three HIV co-infected patients showed an early virological response with loss of HCV RNA, but two subsequently relapsed after 3 and 6 months of therapy. Four patients stopped treatment early (one at 4, one at 7 and two at 9 months) because of treatment-related side effects, although three of these have maintained a virological response. Seventeen patients completed the 48-week course. Twenty of the 28 (71%) treated have had a durable virological response with a median follow-up of 16 months (range 1-24). Combination therapy represents a significant advance in the treatment of hepatitis C in patients with hereditary bleeding disorders.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham; Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: P L
authors.initials: PL
authors.lastname: Shields
authors.forename: D J
authors.initials: DJ
authors.lastname: Mutimer
authors.forename: D
authors.initials: D
authors.lastname: Muir
authors.forename: S
authors.initials: S
authors.lastname: Skidmore
authors.forename: T
authors.initials: T
authors.lastname: Britnell
authors.forename: A
authors.initials: A
authors.lastname: Roberts
authors.forename: J T
authors.initials: JT
authors.lastname: Wilde
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006474:Hemorrhagic Disorders / Q000150:complications* / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D004338:Drug Combinations; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin