In Japan, the human immunodeficiency virus (HIV) and hepatitis C virus (HCV)
coinfection of some patients with
hemophilia was caused by the transfusion of imported blood products, such as unheated
coagulation factor. With the development of antiretroviral
therapy (ART) for HIV, chronic HCV
infection has become a major cause of
liver disease and mortality for hemophiliac patients coinfected with HCV/HIV. Data is limited regarding the efficacy and safety of
antiviral therapy with the HCV
protease inhibitor telaprevir (TVR) in combination with pegylated
interferon-α (PegIFN-α) and
ribavirin (RBV) for
hemophilia patients coinfected with HCV/HIV. We report a case of a Japanese patient with
hemophilia and HCV/
HIV coinfection who had partial response to prior to PegIFN-α and RBV
therapy. This is the first published report of 24-week TVR-based triple
therapy for a
hemophilia patient coinfected with HCV/HIV. The patient had HCV genotype 1a
infection with a high viral load. His single-nucleotide polymorphism of the
interleukin 28B (rs8099917) gene was the TT major allele. He presented with undetectable HIV
RNA and a high CD4(+) T cell counts by taking ART including
tenofovir,
emtricitabine and
raltegravir. He was again treated for HCV with TVR plus PegIFN-α2b and RBV for the first 12 weeks, followed by the continuation of PegIFN-α2b and RBV for 12 additional weeks while continuing ART. He had rapid virological response and achieved sustained virological response with the 24-week treatment. No serious adverse events such as
skin rash, severe
anemia or exacerbated
bleeding tendency were observed, only a mild
headache. No dose adjustment was necessary when
tenofovir and
raltegravir were used in combined with TVR, and no HIV breakthrough was observed. TVR-based triple
therapy with ART could can an effective treatment for
hemophilia patients coinfected with HCV (genotype 1)/HIV regardless of prior response. TVR can be used in combination with
tenofovir,
emtricitabine and
raltegravir for patients with
hemophilia. Furthermore, patients with undetectable HCV
RNA at week 4 could be successfully treated with a 24-week regimen.