Hepatitis C virus (HCV) infection is a growing epidemic worldwide, with about 170 million cases reported by 2011.1 New therapies have been introduced to the market, but the prior mainstay of therapy involves pegylated interferon-alpha (IFN) along with ribavirin (RBV).2 Treatment with the first generation direct-acting antiviral agent-containing regimens consisted of at least 24 weeks of therapy, with the goal of sustained viral response (SVR) – no detectable virus 24 weeks after treatment is completed. We report two cases in which therapy was terminated early due to the developed of severe infection, yet the patients still achieved SVR.
A 54 year old woman with a benign meningioma, who had recently had the tumor resected, was found to have abnormal liver function tests. Subsequent testing revealed she had chronic HCV infection, genotype 3a, with a baseline viral load of 1.57x106 IU/mL. There were no signs of chronic liver disease on exam, and an ultrasound of her abdomen revealed normal liver echogenicity without cirrhosis or hepatocellular carcinoma. 24 weeks of IFN and RBV was planned. After 4 weeks of treatment, she had no detectable virus (rapid virologic response). Although she tolerated the therapy, after 5 weeks of initiation, the patient developed a wound infection at the bifrontal craniotomy surgical site requiring a re-operation. The treatment was terminated and no further treatment plans were made with an IFN-based regimen. 24 weeks after early termination of treatment, at just 5 weeks, the patient had SVR and was feeling well.
A 63 year old man with history of melanoma and thyroid goiter, presented for retreatment of genotype 1 HCV with cirrhosis after relapsing to a prior 48-week course of IFN and RBV, two years earlier. He was Child-Pugh class A and had no evidence of liver decompensation on examination. His baseline HCV RNA was 1.50x106 IU/ mL. He started treatment with IFN, RBV and telaprevir. He experienced side effects of therapy including anorectal burning, constipation, fatigue, and anemia requiring erythropoetin injections. He also achieved rapid virologic response at one month into therapy. Three months into therapy, the patient developed an abscess in the right axilla, which required surgical drainage and an indwelling drain. Antiviral therapy was terminated at that time. 64 weeks after termination of treatment, the patient remains in SVR with no complaints.
Shah, MD, Apeksha and Fenkel, MD, Jonathan
"Hepatitis C Therapy: Serendipitous Successes,"
The Medicine Forum:
Vol. 15, Article 20.
Available at: http://jdc.jefferson.edu/tmf/vol15/iss1/20