Treatment of hepatitis C related thrombocytopenia with interferon alpha

Thrombocytopenia is a common extrahepatic manifestation of hepatitis C (HCV ) infection. Treatment with steroids may be effective, but can exacerbate t he viral Infection. Interferon alpha (INF) has documented efficacy in the t reatment of HCV, but its use In the treatment of HCV thrombocytopenia is co ntroversial. We treated eight patients with HCV-related thrombocytopenia, w ho had platelet counts of fewer than 50 x 10(9)/l (range: 16 to 46 x 10(9)/ L) with INF 3 MU SQ three times a week. Planned duration of treatment was 2 4 weeks. Five patients had no evidence of hepatic cirrhosis, three had cirr hosis, and two had palpable splenomegaly. Only three patients tolerated the full course of treatment, and all three had improvement in their platelet counts to greater than 50 x 10(9)/l. Two other patients had improvement in platelet counts to more than 50 x 10(9)/l with shorter duration of treatmen t (six and 16 weeks, respectively). The mean increase In platelet count in the five responders was 44 x 10(9)/IL (range: 28 to 90 x 10(9)/l). The aver age peak platelet count in the responders was 81 x 10(9)/l (range: 62 to 13 6 x 10(9)/l). Duration of response ranged from four to 18+ months, with the shortest responses observed In the two patients treated with a shorter cou rse of INF. Response was independent of the presence of cirrhosis. Respondi ng patients had improvement in hepatic transaminases, reduction in cryoglob ulin and anticardiolipin antibodies, and HCV plasma RNA when tested. Relaps e was associated with an increase in these laboratory markers of HCV infect ion. We conclude that INF can be an effective treatment in patients with HC V-related thrombocytopenia. (C) 2001 Wiley-Liss, Inc.