Telaprevir-Based Triple Therapy of Hepatitis C Infection in a Patient with Hemophilia A and Factor VIII Inhibitor: Decreased Need for Factor VIII with Viral Suppression: 1069

Purpose: Chronic hepatitis C virus (HCV) infection has been a heavy burden to patients with hemophilia. Patients with hemophilia A frequently receive transfusion of factor VIII as part of their management which can lead to development of antibodies that can neutralize factor VIII. HCV infection by itself and its treatment with interferon can lead to the development of autoantibodies including acquired factor VIII inhibitor. Therefore, treating HCV in hemophiliacs with factor VIII inhibitor remains challenging. A 22-year-old male with a history significant for hereditary hemophilia A complicated by refractory high titer factor VIII inhibitors and hepatitis C genotype 1a infection diagnosed at the age of 1 year was referred to our clinic regarding hepatitis C treatment. The patient has been treated with recombinant human factor VIII 6,000 IU Bid to maintain his factor level at around 20%. He was also receiving rituximab (to help decrease his factor VIII autoantibodies) every 4-6 months for 3 years. Liver biopsy was not performed prior to starting HCV treatment due to concerns about bleeding and the patient was HCV treatment naive. Patient was started on hepatitis C telaprevir-based triple therapy (telaprevir 750 mg TID, weight based ribavirin, and peg-interferon α-2a) with good virologic response (HCV RNA was undetectable at treatment weeks 4, 12, and 24). He qualified for response-guided therapy and he completed his treatment at 24 weeks. He tolerated therapy relatively well without the need to dose reduce his ribavirin or peg-interferon α-2a. Interestingly, within a few days after starting telaprevir therapy, his factor VIII level started to increase significantly and after four weeks of hepatitis C treatment, his factor VIII inhibitor screen was negative and his need for recombinant factor VIII decreased by 50% as shown in the Figure. To our knowledge, this is the first case report on using telaprevir-based triple therapy in a hemophilia patient with factor VIII inhibitor. This case demonstrates that HCV therapy was safe and that suppressing HCV may help decrease factor VIII inhibitor level and the need for recombinant factor VIII. We hope that our report will encourage other practicing clinicians to treat this challenging patient population.Figure: [1069]Disclosure: Naim Alkhouri, MD - Speaker's Bureau and Advisory Board Member of Vertex (makers of telaprevir). Nizar N Zein: - Speaker's Bureau and Advisory Board Member of Vertex (makers of telaprevir).