Changes in HCV Viremia following LDL Apheresis in a HCV Positive Patient with Familial Hypercholesterolemia

Abstract

It has been suggested that hepatitis C virus (HCV) can be associated with beta-lipoprotein in human serum. According to this, the LDL receptor could promote endocytosis of such a virus. In the present study, we evaluated the changes in HCV viremia in a HCV positive patient with familial hypercholesterolemia, undergoing both selective (DALI System, Fresenius) and non-selective (plasma exchange) LDL apheresis. HCV-RNA levels did not decrease following selective LDL apheresis, on the contrary showed a random, odd variation pattern (from -35% to +72%). Conversely, plasma exchange steadily induced a drop in HCV viremia (-35/43%), to a lower extent than that of a totally intravascular plasmaprotein, i.e., alpha 2-macroglobulin (-53/54%). These data indicate that beta-lipoprotein may not function as a plasma carrier of HCV, at least in the present case. Moreover, a continuous, quantitatively unforeseeable circulation of HCV virions from the intravascular plasma compartment to other extravascular and intracellular sites, seems to occur during an apheresis session.

Double filtration plasmapheresis and interferon combination therapy for chronic hepatitis C patients with genotype 1 and high viral load

“…Marson et al . reported that low‐density lipoprotein‐cholesterol apheresis and plasma exchange in hypercholesteremia patients with HCV infection reduced the quantity of HCV‐RNA in the blood of some cases 11 . Ishida et al .…”

“…[6][7][8][9][10] Marson et al reported that low-density lipoprotein-cholesterol apheresis and plasma exchange in hypercholesteremia patients with HCV infection reduced the quantity of HCV-RNA in the blood of some cases. 11 Ishida et al found that hemodialysis, hemofiltration and peritoneal dialysis in chronic dialysis patients infected with HCV produced significantly lower HCV-RNA levels in the blood. 12 There are reports of combined granulocyte apheresis with IFN therapy for chronic hepatitis C, [13][14][15] and also reports claiming that early reduction of the virus is important in the treatment of chronic hepatitis C. 16,17 Thus, the potential effectiveness of IFN therapy combined with early virus removal by a physical method is of particular interest.…”

Double-Filtration Plasmapheresis plus IFN for HCV-1b Patients with Non-Sustained Virological Response to Previous Combination Therapy: Early Viral Dynamics

“…The mechanisms of the clinical results of plasmapheresis have been described, whereby HCV in the blood is related to the effects of IFN therapy that could be enhanced by removing the virus from blood [12][13][14] . Low-density lipoprotein-cholesterol apheresis and plasma exchange in hypercholesteremic patients with HCV infection reduces the quantity of HCV RNA in the blood of some patients [15] . Hemodialysis, hemofiltration and peritoneal dialysis in chronic dialysis patients infected with HCV significantly lower HCV RNA levels in the blood [16] .…”