43-year-old male infected with HCV genotype 1a and human immunodeficiency virus (HIV), with grade F4 hepatic fibrosis (cirrhosis), FibroScan 27 kPabin and Child-Pugh treatment for HIV).
The patient had PR below the normal levels (<120 x 109/L) since the diagnosis of CHC (March 2008).
Before starting antiviral therapy for HCC, the patient had grade III thrombocytopenia (PR = 42 x 109/L), grade III neutropenia (Neutrophils = 0.66 x 109/L) and normal haemoglobin (Hb) values.
Alanine-aminotransferase (ALT) and asbestos-aminotransferase (AST) levels were within normal limits (35 and 36 IU/mL), while gamma-glutamyl (GT) was slightly elevated (62 IU).
HCV viral load was 180,000 copies/mL and CVVIH was undetectable.
In March 2012 she started treatment for CHC with pegIFN-α2a and RBV (180 mcg/week and 1000 mg/day, respectively) for 11 weeks.
At week 12, the PR was 26 x 109/L, and the TVR (mg/8hour).
The PR decreased progressively to 16 x 109/L at week 14, when treatment with eltrombopag 50 mg/day was initiated and the dose of pegIFN-α2a was reduced to 135 mcg/week.
At weeks 16 and 17 the PR remained below normal values (14 x 109/L and 13 x 109/L, respectively).
At week 22 the PR was increased to 34 x 109/L and the dose of eltrombopag was increased to 75 mg/day; the type of IFN (from pegIFgIFN-αVR2a to placebo) was modified
The dose of eltrombopag was reduced to 50 mg/day at week 30 and at week 35 was suspended due to PR of 50 x 109/L. At the end of treatment (week 48), the PR was 67 x 109/L.
