Sustained response to combination therapy in a patient with chronic hepatitis C and thrombocytopenia secondary to alpha-interferon

Recent data suggest that hepatitis C viral (HCV) infection may induce a sig nificant autoimmune reaction to platelets, but the mechanism is unknown. Ma ny patients with chronic hepatitis C, in fact, have high levels of platelet -associated immunoglobulin G (PAIgG) and HCV-RNA is present in the platelet s of 100% of those patients with thrombocytopenia and high PAIgG levels. He patitis C virus infection has been associated with the development of throm bocytopenic purpura, sometimes triggered during interferon (IFN) therapy. I n such cases, the treatment of the underlying disease is a difficult proble m to solve. We report the case of a patient with chronic hepatitis C, who d eveloped life-threatening thrombocytopenic purpura after a prolonged course of IFN-alpha(2b) over a 4-year period. Treatment with anti-immunoglobulin gammaglobulin (Polyglobin(R); Quimica Farmaceutica Bayer, Barcelona, Spain) had a transient effect on the platelet count, but prolonged therapy with p rednisone was necessary for definitive relief of the haematological complic ation. Two years later, the patient was treated with combined therapy, incl uding ribavirin (1200 mg/day) and IFN-alpha(2b) (5 mU, t.i.w.) for 12 month s. This therapy induced a sustained response, both biochemical and virologi cal, without haematological complications. This observation suggests that r ibavirin may be of benefit in the treatment of immune-mediated thrombocytop enia in patients with chronic hepatitis C, preventing the harmful effect of IFN-alpha but also allowing both drugs to be combined so as to increase th e probability of sustained remission of the liver disease. (C) 2000 Blackwe ll Science Asia Pty Ltd.