doi: 10.2169/internalmedicine.9671-17 Intern Med 57: 951-956, 2018 http://internmed.jp
【 CASE REPORT 】
Late Relapse after a Sustained Virologic Response at 24 Weeks after Treatment with Daclatasvir and Asunaprevir Combination Therapy for Chronic Hepatitis C Virus Genotype 1b Infection with Liver Cirrhosis Haruki Uojima 1, Shuko Murakami 2, Seigo Nakatani 1, Hisashi Hidaka 1, Atsuko Takeuchi 1, Yoshiaki Tanaka 1, Tomoyoshi Inoue 1, Keiko Yamane 1, Kousuke Kubota 1, Takahide Nakazawa 1, Akitaka Shibuya 1, Yasuhito Tanaka 2 and Wasaburo Koizumi 1
Abstract: There have been few studies on relapse after a sustained virological response in hepatitis C virus (HCV) patients treated with interferon-free regimens. Thus, the risk of late relapse in patients treated with interferonfree therapy remains unclear. A 67-year-old woman with HCV genotype 1b and liver cirrhosis received oral daclatasvir and asunaprevir. Combination therapy was stopped after 4 weeks because of an episode of encephalopathy. Nonetheless, an HCV polymerase chain reaction at 24 weeks posttreatment was negative. However, HCV ribonucleic acid was detectable at approximately 62 weeks posttreatment. Very late HCV relapses may occur in patients with liver cirrhosis who receive an interferon-free regimen when the treatment period is insufficient. Key words: asunaprevir, daclatasvir, interferon-free regimen, late relapse, liver cirrhosis (Intern Med 57: 951-956, 2018) (DOI: 10.2169/internalmedicine.9671-17)
therapy (DCV+ASV) for chronic HCV genotype 1b infection.
Introduction A sustained virological response (SVR), which reduces the risk of hepatocellular carcinoma and cirrhosis, is accepted as a durable and clinically significant treatment endpoint of hepatitis C virus (HCV) therapy (1). HCV ribonucleic acid (RNA) negativity at 12 and 24 weeks posttreatment is currently accepted as the definition of an SVR (2). A number of studies have analyzed the rate of relapse after a SVR with interferon-based therapies in a range of patient populations (3-5). However, there have been few studies on relapse after treatment with interferon-free regimens. Thus, the risk of late relapse with interferon-free therapy remains unclear. We herein describe a case of late relapse after an SVR in a patient with liver cirrhosis who was treated with daclatasvir (DCV) and asunaprevir (ASV) combination
Case Report A 67-year-old woman was presented to our hospital to undergo evaluation for HCV genotype 1b with liver cirrhosis. She had not previously received conventional interferon therapy. She was human immunodeficiency virus (HIV)negative. There was no history of HCV infection in her family. On physical examination, vascular spider was observed on her subclavicular upper left thorax, without jaundice. Her laboratory data upon admission for combination therapy are shown in Table 1. HCV infection (genotype 1b) was confirmed by an HCV-polymerase chain reaction (PCR). Her plasma HCV RNA load, as quantified using a Cobas TaqMan version 2.0 assay (Roche Diagnostics, Tokyo, Ja-
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Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan and ２ Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Japan Received: June 15, 2017; Accepted: July 25, 2017; Advance Publication by J-STAGE: December 8, 2017 Correspondence to Dr. Haruki Uojima,
[email protected]
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Intern Med 57: 951-956, 2018
DOI: 10.2169/internalmedicine.9671-17
Table 1. Laboratory Data on Admission for Combination Therapy. Complete Blood Count
Case 1
Hemoglobin White blood cells Neutrophils Platelets
13.5 4.0 2.1 6.3
Normal range 11.5-15.0 4.0-9.0 1.7-6.4 15.0-35.0
g/dL ×103/μL ×103/μL ×104/μL
Coagulation Prothrombin
85
70-130 %
Biochemistry AST ALT Albumin BUN Creatinine Total bilirubin ZTT TTT M2BPGi Hyaluronic acid Alpha-fetoprotein PIVKA-2
85 66 3.2 15.1 0.5 1.5 13.8 25.1 9.07 387 5 7
10-35 5-40 3.8-5.2 8.0-22.0 0.40-0.80 0.2-1.0
