Chronic viral hepatitis C with a pronounced autoimmune component, successfully docked after therapy with direct-acting antivirals

Abstract

The presented 18-year follow-up of a 46-year-old patient E. with chronic hepatitis C genotype 1B with a pronounced autoimmune component demonstrates the difficulties of diagnosis and treatment of this form of the disease. By the beginning of observation (in April 2001) the disease was manifested by a slight increase in the liver and moderate splenomegaly with thrombocytopenia, pronounced cytolysis and cholestasis syndrome (Alat and ASAT Activity exceeded the norm by nine times; γ-GT activity was higher than the norm by five times). HCV RNA was detected at a concentration of 3,1 × 10 ⁵ IU/ml, genotype 1b, followed by an increase in the virus content to 8,8 × 10 ⁵ IU/ml. Autoimmune markers: ANF, anti-LKM-1, SMA, IgG were significantly increased. Given that interferon could lead to an exacerbation of the autoimmune component, immunosuppressive therapy carried out before interferon and ended with a slow normalization of autoimmunity markers. The course of treatment with realdiron after that was ineffective, but autoimmune markers increased. In subsequent years, the patient had an undoubted progression of liver cirrhosis, as evidenced by increased portal hypertension, increased degree of liver fibrosis. Approval of non-interferon schemes of antiviral therapy allowed without risks to carry out treatment with drugs with direct antiviral action. From 01.04 15.10.2016 the city conducted, a 24-week course of treatment with sofosbuvir at a dose of 400 mg concurrently with 90-mg. ladypassion in 2 weeks achieved sustained virologic response, and then normalized modified autoimmune markers. There is a tendency to reduce the severity of liver fibrosis. The positive effect preserved to the present time (about 3 years).