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215 were recruited from a named patient program created to ensure early access to interferon ‐free therapy for patients with the risk of unfavorable course of chronic HCV infection. Antiviral medi‐ cations were provided by the manufacturer (Ab‐ bVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany). Adult patients with chronic HCV gen‐ otype 1b infection with definitive or probable AIH were enrolled. Patients with HIV or hepatitis B virus coinfection, other concomitant liver diseas‐ es, and hepatocellular carcinoma were excluded. Screening for hepatocellular carcinoma included serum α ‐fetoprotein measurement and abdom‐ inal ultrasound within 1 month prior to antivi‐ ral therapy. Patients declared no drug or alco‐ hol abuse as well as no hepatotoxic drug use for at least 6 months prior to the study. Patients fol‐ lowing previous antiviral treatment other than DAA and immunosuppressive therapy were eli‐ gible, provided there were no contraindications to antiviral therapy. Four patients met the protocol criteria. All pa‐ tients were white Europeans. The clinical charac‐ teristics of the patients are presented in TABLE 1. Antiviral treatment with ombitasvir/paritapre‐ vir (boosted with ritonavir) and dasabuvir (3D), with or without ribavirin (OBV/PTV/r/DSV ±RBV; 3D ±RBV) was scheduled for 12 weeks. The dose of coformulated OBV/PTV/r was 25 mg/d, 150 mg/d, and 100 mg/d, respectively, and the dose of DSV was 500 mg/d divided into 2 doses. One patient received RBV at a dose of 1200 mg/d. There were 7 time points with laboratory test‐ ing and clinical assessment: baseline, 1st week of therapy, 4th week of therapy, end of treatment, as well as 24 ‐week, 48 ‐week, and 2 ‐year follow ‐up. Introduction The prevalence of autoimmune hep‐ atitis (AIH) is 160 to 170 per 1 000 000 popula‐ tion in Europe, with women being more frequent‐ ly affected.1 According to the International Auto‐ immune Hepatitis Group (IAIHG) scoring system last revised in 2015, AIH is diagnosed on the ba‐ sis of biochemical and serological tests along with histologic examination of the liver.1,2 Optimal therapy is challenging when AIH is accompanied by chronic hepatitis C, as these 2 conditions re‐ quire different therapeutic strategies. Until 2014, the only available antiviral therapy was interfer‐ on alfa, associated with the risk of exacerbation of autoimmune diseases. On the other hand, im‐ munosuppressive treatment could enhance viral replication. The new interferon ‐free regimens with direct ‐acting antiviral agents (DAAs) are promising for this difficult ‐to ‐treat population.3 In 2015, an estimated 71 million people suffered from chronic hepatitis C virus (HCV) infection, with the highest reported prevalence in the East‐ ern Mediterranean Region and European Region according to the World Health Organization.4 The prevalence of HCV infection with concomi‐ tant AIH remains unknown. New effective ther‐ apies are now broadly available; however, data re‐ garding the safety and efficacy of DAAs in these patients are limited. The aim of this study was to evaluate the po‐ tential impact of interferon ‐free antiviral thera‐ py on AIH activity in patients with HCV infection and AIH in a long ‐term follow ‐up.

Risk of autoimmune hepatitis reactivation in patients with chronic hepatitis C and autoimmune hepatitis treated with direct-acting antivirals