2019 Research Forum

Applicant: Harleen Sandhu RA Principal Investigator & Faculty Sponsor: Arash Heidari MD

A Case of Hepatitis C: Two Decades of Waiting for Godot or Cure

Harleen Sandhu RA, Arash Heidari MD, Drew Mahoney MS IV, Royce Johnson MD

INTRODUCTION Describing a challenging case of chronic hepatitis C that failed treatment twice 20 years prior; the patient returned and was placed on a direct acting agent, and this report will compare her response to current treatment 20 years later. PURPOSE Treatment of hepatitis C has evolved drastically over last several years. The response rate has improved from less than 20% in early 1990s to over 90% recently. Treatment modalities have evolved from barely tolerable with serious adverse reaction to almost well tolerated treatment with minimal side effects such as with direct acting agents. IRB review and approval for the case report was obtained. DISCUSSION A 56 years old Hispanic female presented to our hepatitis clinic 22 years ago with diagnosis of hepatitis C. Her viral load was over one million copies. She had no clinical evidence of cirrhosis and her only risk factor was exposure to reused needles, for medical purposes, in Mexico before her immigration to US. A liver biopsy showed heavy portal lymphoid infiltrates, fatty changes, and hepatocytolysis. Her genotype was 1a and treatment was started with non-PEGylated Interferon alpha 2a three times per week for 24 weeks. She failed treatment with viral load of over one million at the end of therapy. One and half years later, she was started on combination of interferon 2b 3 times a week with daily ribavirin for 48 weeks. Before end of treatment course she developed severe neutropenia and therefore, treatment was stopped. Her viral load was 43,000. Liver biopsy showed grade 3 inflammation with stage 4 fibrosis. She was lost to follow up but came back to our clinic 15 years later. Her viral load was less than a million and her fibrosis score (Fibro Sure) came back as F3 and A3. She had negative screening for hepatocellular carcinoma with ultrasound and AFP. She was placed on combination treatment of Glecaprevir plus Pibrentasvir for 12 weeks duration. She experienced mild side effects for initial one week of treatment: sleepiness, headache, fatigue. Patient achieved sustained virologic response or SVR, 12 weeks after completion of her treatment. CONCLUSION In the era of direct acting agents, treatment of hepatitis C is in its golden time. There should be more public education to encourage patients with previous failed attempts that the wait is over, and that cure is within reach.

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