J Infect Chemother xxx (2014) 1e3
Contents lists available at ScienceDirect
Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic
Case report
Efficacy of re-treatment by peginterferon alpha-2a and ribavirin in a child with hepatitis C Shigeo Nishimata, Norito Tsutsumi, Shunsuke Suzuki, Ryuhei Nagao, Yasuyo Kashiwagi, Hisashi Kawashima* Department of Pediatrics, Tokyo Medical University, Japan
a r t i c l e i n f o
a b s t r a c t
Article history: Received 2 February 2014 Received in revised form 12 February 2014 Accepted 13 February 2014
Background: There is currently no consensus treatment for children non-responsive to peginterferon (Peg-IFN) and ribavirin. Case presentation: Here, we present a Japanese child with chronic hepatitis C with fibrosis, who did not respond to Peg-IFN a-2b but responded to Peg-IFN a-2a with ribavirin, accompanied with fluvastatin. To date, there has been no reported case of re-treatment in children. The early viral response occurred soon after starting treatment using Peg-IFN a-2a/ribavirin plus fluvastatin. Conclusion: Our result indicates that when treatment by Peg-IFN a-2b/ribavirin combination therapy is not efficient, combination therapy using Peg-IFN a-2a/ribavirin plus fluvastatin should be considered in children with advanced liver change. Ó 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords: Peginterferon Ribavirin Fluvastatin Non-responsive Sustained virologic response
1. Introduction Hepatitis C virus (HCV) is often persistent and progresses to liver cirrhosis through chronic hepatitis, especially in cases of mother-to-child transmission. Natural cure is rare, and hepatocellular carcinoma occurs frequently, at an annual rate of 7e8% of patients with HCV-related cirrhosis. There is a clear correlation between the severity of liver fibrosis and the ratio of liver cell carcinoma. Recently, treatments for HCV have been developed. In Japanese adults, about 50% of patients having genotype 1 and 90% of patients having HCV of genotype 2 or 3 have been cured by interferon therapy, with or without ribavirin [1]. However, not much is known about the effectiveness of this therapy in children. A recent review by Hu et al. that evaluated data from 4 randomized controlled trials and 31 non-randomized studies indicates that the sustained virologic response (SVR) of interferon/ribavirin treatments for HCV genotype 1 was 51%; for genotype 2 or 3, 98%; and for genotype 4, 75%, in childhood cases [2].
* Corresponding author. Department of Pediatrics, Tokyo Medical University, 6-71 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Tel.: þ81 3 3342 6111; fax: þ81 3 3344 0643. E-mail address: [email protected] (H. Kawashima).
There is currently no consensus treatment for children nonresponsive to peginterferon (Peg-IFN) and ribavirin. Here, we present a Japanese child with chronic hepatitis C with fibrosis, who did not respond to Peg-IFN a-2b/ribavirin but responded to Peg-IFN a2a with ribavirin, accompanied with fluvastatin.
2. Case report The patient was vaginally born normal for date (weight: 3300 g at 39 weeks), without any complication. At the age of 5 months, liver dysfunction was noted, and the child tested positive for HCV RNA. At the time, his father had Buerger’s disease and his mother was positive for HCV (1b). In May 2010, at the age of 7 years, the patient was admitted to our hospital for liver biopsy and other liver tests. Physical examination was not remarkable. His body mass index (BMI) was 15.7 kg/ m2; blood pressure, 102/72 mmHg; and body temperature, 37.0 C. Hepatosplenomegaly was not found. The white blood cell count was 8500/mL (neutrophils 50.25%, lymphocytes 38.5%, eosinophils 2.1%, basophils 0.7%), and haemoglobin, 13.4 g/dL. The number of platelets was 345 103/mL. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-GTP were 67 IU/L, 118 IU/L, and 57 IU/L, respectively (normal range: AST < 38, ALT < 44, gamma-GTP < 50). Total bilirubin and direct bilirubin were 0.61 mg/dL and 0.14 mg/dL,
http://dx.doi.org/10.1016/j.jiac.2014.02.004 1341-321X/Ó 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Nishimata S, et al., Efficacy of re-treatment by peginterferon alpha-2a and ribavirin in a child with hepatitis C, J Infect Chemother (2014), http://dx.doi.org/10.1016/j.jiac.2014.02.004
2
S. Nishimata et al. / J Infect Chemother xxx (2014) 1e3
respectively, while ALP was 826 U/L. Procollagen III peptide (P-III-P) had elevated to 1.3 U/mL. Type IV collagen was 182 ng/mL. Total bile duct acid was 28.4 mmol/L (
Contents lists available at ScienceDirect
Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic
Case report
Efficacy of re-treatment by peginterferon alpha-2a and ribavirin in a child with hepatitis C Shigeo Nishimata, Norito Tsutsumi, Shunsuke Suzuki, Ryuhei Nagao, Yasuyo Kashiwagi, Hisashi Kawashima* Department of Pediatrics, Tokyo Medical University, Japan
a r t i c l e i n f o
a b s t r a c t
Article history: Received 2 February 2014 Received in revised form 12 February 2014 Accepted 13 February 2014
Background: There is currently no consensus treatment for children non-responsive to peginterferon (Peg-IFN) and ribavirin. Case presentation: Here, we present a Japanese child with chronic hepatitis C with fibrosis, who did not respond to Peg-IFN a-2b but responded to Peg-IFN a-2a with ribavirin, accompanied with fluvastatin. To date, there has been no reported case of re-treatment in children. The early viral response occurred soon after starting treatment using Peg-IFN a-2a/ribavirin plus fluvastatin. Conclusion: Our result indicates that when treatment by Peg-IFN a-2b/ribavirin combination therapy is not efficient, combination therapy using Peg-IFN a-2a/ribavirin plus fluvastatin should be considered in children with advanced liver change. Ó 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords: Peginterferon Ribavirin Fluvastatin Non-responsive Sustained virologic response
1. Introduction Hepatitis C virus (HCV) is often persistent and progresses to liver cirrhosis through chronic hepatitis, especially in cases of mother-to-child transmission. Natural cure is rare, and hepatocellular carcinoma occurs frequently, at an annual rate of 7e8% of patients with HCV-related cirrhosis. There is a clear correlation between the severity of liver fibrosis and the ratio of liver cell carcinoma. Recently, treatments for HCV have been developed. In Japanese adults, about 50% of patients having genotype 1 and 90% of patients having HCV of genotype 2 or 3 have been cured by interferon therapy, with or without ribavirin [1]. However, not much is known about the effectiveness of this therapy in children. A recent review by Hu et al. that evaluated data from 4 randomized controlled trials and 31 non-randomized studies indicates that the sustained virologic response (SVR) of interferon/ribavirin treatments for HCV genotype 1 was 51%; for genotype 2 or 3, 98%; and for genotype 4, 75%, in childhood cases [2].
* Corresponding author. Department of Pediatrics, Tokyo Medical University, 6-71 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Tel.: þ81 3 3342 6111; fax: þ81 3 3344 0643. E-mail address: [email protected] (H. Kawashima).
There is currently no consensus treatment for children nonresponsive to peginterferon (Peg-IFN) and ribavirin. Here, we present a Japanese child with chronic hepatitis C with fibrosis, who did not respond to Peg-IFN a-2b/ribavirin but responded to Peg-IFN a2a with ribavirin, accompanied with fluvastatin.
2. Case report The patient was vaginally born normal for date (weight: 3300 g at 39 weeks), without any complication. At the age of 5 months, liver dysfunction was noted, and the child tested positive for HCV RNA. At the time, his father had Buerger’s disease and his mother was positive for HCV (1b). In May 2010, at the age of 7 years, the patient was admitted to our hospital for liver biopsy and other liver tests. Physical examination was not remarkable. His body mass index (BMI) was 15.7 kg/ m2; blood pressure, 102/72 mmHg; and body temperature, 37.0 C. Hepatosplenomegaly was not found. The white blood cell count was 8500/mL (neutrophils 50.25%, lymphocytes 38.5%, eosinophils 2.1%, basophils 0.7%), and haemoglobin, 13.4 g/dL. The number of platelets was 345 103/mL. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-GTP were 67 IU/L, 118 IU/L, and 57 IU/L, respectively (normal range: AST < 38, ALT < 44, gamma-GTP < 50). Total bilirubin and direct bilirubin were 0.61 mg/dL and 0.14 mg/dL,
http://dx.doi.org/10.1016/j.jiac.2014.02.004 1341-321X/Ó 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Nishimata S, et al., Efficacy of re-treatment by peginterferon alpha-2a and ribavirin in a child with hepatitis C, J Infect Chemother (2014), http://dx.doi.org/10.1016/j.jiac.2014.02.004
2
S. Nishimata et al. / J Infect Chemother xxx (2014) 1e3
respectively, while ALP was 826 U/L. Procollagen III peptide (P-III-P) had elevated to 1.3 U/mL. Type IV collagen was 182 ng/mL. Total bile duct acid was 28.4 mmol/L (
