Severe immune thrombocytopenia after peg-interferonalpha2a, ribavirin and telaprevir treatment completion: a case report and systematic review of literature

Mild to moderate autoimmune thrombocytopenia(AITP) is a common finding in patients receiving interferonbased antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus(HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferonbased antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment(i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferonbased treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but alsoafter discontinuation.

Telbivudine:A new treatment for chronic hepatitis B

世界范围的 3.5 亿个人被估计长期地感染肝炎 B。这些题目的 15%-40% 将在他们的生活期间开发肝硬化，肝失败或肝细胞癌。长期的肝炎 B 的治疗在最后十年优点上戏剧性地改善了到 nucleoside/nucleotide 类似物的来临和 pegylated 干扰素的使用。为长期的肝炎 B 治疗的同意的药包括：标准 interferon-alpha 2b， pegylated interferon-alpha 2a， lamivudine， adefovir dipivoxil，和 entecavir。不幸地，这些代理人不在所有病人是有效的并且与不同副作用被联系。干扰素有众多的副作用和类似物，很好被容忍，需要被用于延长时期的核甙或核苷酸，甚至无止境地。然而，与核甙延长了治疗或核苷酸类似物与抵抗的高率被联系。Telbivudine 是为在长期的肝炎 B 的治疗的使用的新奇、口头上地管理的核甙类似物。与另外的核甙类似物相对照， Telbivudine 没与 mitochondrial 毒性与哺乳动物的 DNA 聚合酶的抑制被联系。Telbivudine 与 lamivudine 相比与反应和优异病毒的抑制的显著地更高的率对肝炎 B 表明了有势力活动，标准疗法。Telbivudine 很好通常被容忍了，与低不利效果侧面，并且在它的有效剂量，没有限制剂量的毒性被观察了。Telbivudine 是之一最有势力为长期的肝炎 B 的抗病毒的代理人并且被食物及药品管理局在 2006 年末同意。

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎及其合并人类免疫缺陷病毒感染者的疗效

目的观察人类免疫缺陷病毒（HIV）／丙型肝炎病毒（HCV）合并感染者及HCV单一感染者聚乙二醇干扰素（Peg_INF）联合利巴韦林抗HCV疗效。方法70名HIV／HCv合并感染者（合并感染组）及60例HCV单一感染者（单一感染组），均给予Peg-INFoa-2a联合利巴韦林抗HCV治疗，于治疗0、4、12、24、48周及停药后24周行HCVRNA载量检测。PCR加测序法获得HCV基因型及IL-28B基因rs8099917、rsl2979860及rsl2980275位点基因型。分析两组患者疗效，并分析HCV基因型及IL-28B基因型对疗效的影响。数据采用SPSS16．0软件进行分析。离散型分类计数资料使用x2检验，计量资料使用重复测量数据方差分析、方差分析；独立样本的均数比较采用t检验；对非正态分布数据采用参数检验统计分析。结果持续病毒学应答（SVR）率合并感染组为32．9％，单一感染组为71．7％，两组比较，p=0．000，差异有统计学意义。合并感染组中，HCV-1型和HCV-非1型患者SVR率分别为30．8％和33．3％，P=1．000，差异无统计学意义。单一感染组中，HCV-1型和HCV-非1型患者SVR率分别为86．1％和50．0％，P=0．002，差异有统计学意义。SVR率在HCV-1型单一感染组为86．1％，合并感染组为30．8％，P=0．000，差异有统计学意义。不同IL-28B基因型的疗效，差异无统计学意义。结论单一感染组Peg-INFa-2a联合利巴韦林疗效优于合并感染组；HCV基因1型合并感染组疗效比单一感染组差；IL-28B基因型并不影响Peg-INFa-2a联合利巴韦林疗效。