Autoimmune and Harvoni

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6 January 2019 at 8:59 pm #28901
Penn
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@penn
Has anyone treated with DAAs who also has an autoimmune condition like rheumatoid arthritis or lupus or another one?
What was the outcome? Any flares of autoimmune during DAA treatment?
Can Dr Freeman also comment on his experience with this?
7 January 2019 at 6:31 am #28902
Dr James
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@fixhepc
Hello Penn,

There is quiet a strong association between autoimmunity and Hepatitis C. The immune-related extrahepatic manifestations include:
- Mixed cryoglobulinemia
- Cryoglobulinemic vasculitis
- B-cell non-Hodgkin’s lymphoma.
- Sicca syndrome
- Arthralgia/myalgia
- Polyarthritis/fibromyalgia
- Autoantibody production (i.e. cryoglobulins, rheumatoid factor, and antinuclear, anticardiolipin, antithyroid and anti-smooth muscle antibodies)
- Polyarteritis nodosa
- Monoclonal gammopathies
- Immune thrombocytopenia
- Glomerulonephritis and renal insufficiency
This article speaks to your questions https://rmdopen.bmj.com/content/1/1/e000008 with the answer “we just don’t know”.

This article says “use DMARDs with caution in HCV” http://www.eurjrheumatol.org/sayilar/211/buyuk/194-9.pdf

This article suggests slightly lower SVR rates in patients with autoimmunity https://bmjopengastro.bmj.com/content/5/1/e000203

There is a tiny 3 case series here https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-018-0826-7 showing a transient fall in autoantibodies during treatment

But in terms of a study that said something like “patients with HCV and autoimmunity have reduced autoimmunity on and after HCV treatment” – as far as I know nobody has done a large trial to answer that one way or another.

It sounds like you are weighing up treatment options?

YMMV
13 January 2019 at 9:25 pm #28904
Rick-Hopes-google
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@rick-hopes-google
”DrJames” wrote:
Hello Penn,

There is quiet a strong association between autoimmunity and Hepatitis C. The immune-related extrahepatic manifestations include:

Mixed cryoglobulinemia

Cryoglobulinemic vasculitis

B-cell non-Hodgkin’s lymphoma.

Sicca syndrome

Arthralgia/myalgia

Polyarthritis/fibromyalgia

Autoantibody production (i.e. cryoglobulins, rheumatoid factor, and antinuclear, anticardiolipin, antithyroid and anti-smooth muscle antibodies)

Polyarteritis nodosa

Monoclonal gammopathies

Immune thrombocytopenia

Glomerulonephritis and renal insufficiency

This article speaks to your questions https://rmdopen.bmj.com/content/1/1/e000008 with the answer “we just don’t know”.

This article says “use DMARDs with caution in HCV” http://www.eurjrheumatol.org/sayilar/211/buyuk/194-9.pdf

This article suggests slightly lower SVR rates in patients with autoimmunity https://bmjopengastro.bmj.com/content/5/1/e000203

There is a tiny 3 case series here https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-018-0826-7 showing a transient fall in autoantibodies during treatment

But in terms of a study that said something like “patients with HCV and autoimmunity have reduced autoimmunity on and after HCV treatment” – as far as I know nobody has done a large trial to answer that one way or another.

It sounds like you are weighing up treatment options?
Hey. Thank you very much. This information helped me a lot. I thought I would create a topic. Good luck!
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