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Successful treatment of Japanese hemophilia patient co-infected with HIV and HCV genotype 4a by glecaprevir/pibrentasvir therapy

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Abstract

Although direct-acting antiviral (DAA)-based anti-hepatitis C virus (HCV) therapies are very effective for patients with genotypes 1 and 2, evidence of the efficacy of DAA-based therapy for the special population of patients with genotypes 3–6 is insufficient due to the relatively small number of these subjects in Japan. Human immunodeficiency virus (HIV)/HCV-co-infected patients are recommended to be treated as HCV-mono-infected patients by the latest version of the Japan Society of Hepatology guidelines. However, evidence of efficacy in patients with HIV/HCV genotype 3–6 co-infection is insufficient. Currently, HCV genotypes 3–6 can be treated with two DAA-based therapies, including glecaprevir (GLE)/pibrentasvir (PIB) therapy in Japan. We experienced a relatively rare case of a Japanese hemophilia patient co-infected with HIV/HCV genotype 4a. We evaluated resistance-associated substitutions (RASs) against GLE and PIB before GLE/PIB therapy and found that he had no RASs. He was treated with 12 weeks of GLE/PIB therapy and achieved a sustained virologic response at post-treatment weeks 24. Although the treatment was well tolerated, the patient developed hyper-low-density lipoproteinemia that was probably associated with HCV elimination during the therapy. Additional studies are needed to confirm the efficacy and safety of GLE/PIB therapy for this special population in Japan.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Ken Sato, Yuki Kanayama, Yuichi Yamazaki, Hiroki Tojima, Takayoshi Suga, Daisuke Uehara & Toshio Uraoka

  2. Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan

    Satoru Kakizaki

  3. Infection Control and Prevention Center, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Kunio Yanagisawa

  4. Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, 329-0498, Japan

    Hiroshi Ohnishi & Hiroaki Okamoto

Authors
  1. Ken Sato
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  2. Yuki Kanayama
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  3. Yuichi Yamazaki
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  4. Hiroki Tojima
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  5. Takayoshi Suga
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  6. Daisuke Uehara
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  7. Satoru Kakizaki
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  8. Kunio Yanagisawa
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  10. Hiroshi Ohnishi
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  11. Hiroaki Okamoto
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Corresponding author

Correspondence to Ken Sato.

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Conflict of interest

Takayoshi Suga received research funding from MSD K.K.

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All procedures followed were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient for inclusion in the case report.

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Sato, K., Kanayama, Y., Yamazaki, Y. et al. Successful treatment of Japanese hemophilia patient co-infected with HIV and HCV genotype 4a by glecaprevir/pibrentasvir therapy. Clin J Gastroenterol 14, 1725–1732 (2021). https://doi.org/10.1007/s12328-021-01524-1

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  • DOI: https://doi.org/10.1007/s12328-021-01524-1

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