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Successful treatment with glecaprevir/pibrentasvir for chronic hepatitis C complicated by primary biliary cholangitis

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Abstract

Background

Cases of autoimmune liver diseases complicated with hepatitis C (HCV) infection have occasionally been reported. However, the efficacy and safety of direct acting antivirals for chronic hepatitis C (CHC) complicated with autoimmune liver diseases remain unclear.

Case report

A 74-year-old woman was referred to our hospital for an acute exacerbation of liver dysfunction. She had been diagnosed with CHC 10 years previously. Laboratory data showed elevated immunoglobulin G (IgG), and she was positive for antinuclear antibody (ANA), anti-mitochondrial M2 antibody, and HCV-RNA (genotype 2a). Liver biopsy revealed significant infiltration of lymphocytes and plasma cells in the portal triad, moderate interface hepatitis with mild bridging fibrosis, and chronic non-suppurative destructive cholangitis. She was diagnosed with chronic active hepatitis and primary biliary cholangitis (PBC). Combination therapy with glecaprevir/pibrentasvir (GLE/PIB) rapidly improved her serum transaminase and HCV-RNA levels. A sustained viral response was achieved 24 weeks after GLE/PIB. No adverse events were observed, and her IgG and ANA levels were normalized 6 months after GLE/PIB. The second liver biopsy performed 10 months after GLE/PIB demonstrated the remarkable improvement of active hepatitis. However, the findings suggesting PBC were remained and the AMA-M2 titer was decreased but positive at that time.

Conclusion

GLE/PIB is an effective and tolerated choice for the treatment in cases of CHC complicated by PBC.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan

    Satoshi Takakusagi, Hitoshi Takagi, Yozo Yokoyama, Kyoko Marubashi, Kazuko Kizawa & Takashi Kosone

  2. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Ken Sato, Satoru Kakizaki & Toshio Uraoka

Authors
  1. Satoshi Takakusagi
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  2. Hitoshi Takagi
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  3. Yozo Yokoyama
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  4. Kyoko Marubashi
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  5. Kazuko Kizawa
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  6. Takashi Kosone
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  7. Ken Sato
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  8. Satoru Kakizaki
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  9. Toshio Uraoka
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Corresponding author

Correspondence to Satoru Kakizaki.

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Conflict of interest

K. Sato received research funding from AbbVie. S. Kakizaki received research funding from BMS and Gilead.

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

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Takakusagi, S., Takagi, H., Yokoyama, Y. et al. Successful treatment with glecaprevir/pibrentasvir for chronic hepatitis C complicated by primary biliary cholangitis. Clin J Gastroenterol 13, 896–901 (2020). https://doi.org/10.1007/s12328-020-01103-w

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  • DOI: https://doi.org/10.1007/s12328-020-01103-w

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