Background:Hepatitis C virus infection is one of the most significant public health problems in the world. To date, the problem of selection of therapy is very relevant for patients with autoimmune diseases and chronic hepatitis C [1]. Patients with systemic lupus erythematosus (SLE) are forced to take different doses of steroids, often in combination with immunosuppressants (mycophenolate mofetil, azathioprine, etc.) even in the case of long-term remission. Such therapy for many years can contribute to the reactivation of hepatitis C.Objectives:To describe a clinical case of the effectiveness of the combined use of interferon-free therapy and therapy of steroids in a patient with SLE, secondary Sjogren syndrome and chronic hepatitis C.Methods:56 years-old woman was admitted to the rheumatology department of Clinical Hospital No. 1 in December 2018 with the debut of SLE: photosensitivity, aphthous stomatitis, arthritis, pleurisy, sicca syndrome, leukopenia, ANA 1: 2560, antibodies to dsDNA 55.95 IU / ml, positive antiSS-A (Ro). At the same time, it became known that she was infected with hepatitis C virus in 1985 presumably. At the time of hospitalization, anti-HCV was positive, the virus genotype was 1b, the activity of the process was low (HCV RNA 6.6x104, AST 33 U/L and ALT 25 U/L). The patient was prescribed corticosteroids (methylprednisolone 16 mg/day) and hydroxychloroquine 400 mg/day. In January 2019, after gastroenterologist, hematologist and infectious disease specialist advise, it was decided to conduct the patient a specific interferon-free antiviral therapy for chronic hepatitis C (a 24-week course with asunaprevir and daclatasvir), given the potential long-term glucocorticoid therapy, with the prospect of treating the patient with cytotoxic drugs, and the possibility of reactivation of chronic hepatitis C amid of immunosuppressive therapy for SLE and Sjogren syndrome.Results:Low-disease activity of SLE was achieved in a month, and after 24-week course of antiviral therapy, there was no increase in SLE activity, and positive laboratory and clinical dynamics were noted.Conclusion:Thus, the use of interferon-free therapy of chronic hepatitis C in patients with systemic lupus erythematosus and secondary Sjogren syndrome shows possible ways to safe treatment of this disease in patients with diffuse connective tissue diseases.References:[1]Xiaobo Zhu, Mingqi Wang, Mei Liu, Xinghao Yu & Peng Huang. Efficacy and safety of direct-acting antivirals for treatment-naive patients with genotype 1 hepatitis C virus infection. Per Med. October 2019. 16 (5): 421 doi: 10.2217/pme-2018-0121.Acknowledgments:Supported by the “Russian Academic Excellence Project 5-100”Disclosure of Interests:None declared
How hepatitis C virus modifies the immunological profile of Sjögren syndrome: analysis of 783 patients
