Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Jun 16, 2013; 1(3): 106-107
Published online Jun 16, 2013. doi: 10.12998/wjcc.v1.i3.106
Hepatitis C treatment with triple therapy in a patient with hemophilia A
Gurshawn Singh, Reuben Sass, Rayan Alamiry, Nizar Zein, Naim Alkhouri
Gurshawn Singh, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Reuben Sass, Rayan Alamiry, Nizar Zein, Naim Alkhouri, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Singh G and Alkhouri N designed the report; Singh G, Sass R and Alamiry R analyzed data; Alkhouri N was the attending doctor for the patient; Singh G, Zein N and Alkhouri N wrote the paper.
Correspondence to: Naim Alkhouri, MD, Department of Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Telephone: +1-216-4449000  Fax: +1-216-4442974
Received: February 25, 2013
Revised: April 17, 2013
Accepted: May 8, 2013
Published online: June 16, 2013
Processing time: 107 Days and 5 Hours

We report a case of successful treatment of chronic hepatitis C infection with telaprevir-based triple therapy in a patient with hemophilia A complicated by factor VIII inhibitor. A twenty-two years old male with hereditary hemophilia A and high-titer factor VIII inhibitor was taking maintenance doses of recombinant factor VIII. He visited our clinic for treatment of his chronic hepatitis C with the newly instituted protease inhibitor based therapy. He was diagnosed with hepatitis C genotype 1a at one year of age. He was initiated on telaprevir, ribavirin and peg-interferon for treatment of hepatitis C and qualified for response-guided therapy. He completed treatment at 24 wk with minimal adverse effects. Notably, after 4 wk of hepatitis C treatment, his factor VIII inhibitor screen was negative and the dose for recombinant factor VIII decreased by half of the initial dosing before he was treated for hepatitis C. We suspect that suppressing hepatitis C may help decrease factor VIII inhibitor level and the need for recombinant factor VIII.

Keywords: Hepatitis C virus, Hemophilia, Factor VIII, Telaprevir, Factor VIII inhibitor, Protease inhibitor

Core tip: This is a case of a patient who has Hemophilia A with factor VIII inhibitor and chronic hepatitis C. After successfully treating the patient’s hepatitis C with protease-inhibitor based triple therapy and achieving response-guided therapy with negative hepatitis C virus RNA after week 4, the patient’s need for recombinant factor VIII decreased significantly.