Hepatitis C Case Study: Interferon-Free Therapy Genotype 1a W-Prior Null Response

Hello everyone, Projects in Knowledge launched a couple new learning activities which provide a look at two different hepatitis C patients, each case study is followed by Paul Y. Kwo, MD.  

The first presentation is a genotype1b treatment-naive patient with cirrhosis. The second is a null responder with stage two fibrosis, a highlight of both presentations is provided below. Like any site offering continuing medical education (CME), it requires a free quick registration.

In addition, Ira M. Jacobson, MD will be hosting a satellite symposium on May 03, 2014; Hepatitis C - Hepatitis C Treatment Goes Viral: Let's Talk About Oral Therapies – Satellite Symposium. This CME/CE activity is designed for hepatologists, gastroenterologists, infectious disease specialists, primary care physicians, nurses, and pharmacists involved in the screening and treatment of patients with HCV or those at risk of acquiring the infection.

P. Kwo, MD

Hepatitis C — HCV Case Study: HCV Therapy for a Treatment-Naive Patient with Genotype-1 HCV Infection and Compensated Cirrhosis – Case Study 

Recently approved direct-acting antiviral agents offer new choices for patients with chronic hepatitis C virus infection, including those with cirrhosis. Join Paul Y. Kwo, MD, for this case study in which he follows a cirrhotic treatment-naive patient with genotype-1b infection from assessment through treatment.

Case Presentation - Patient Assessment 

A 68-year-old Hispanic male presented to you for a discussion of HCV treatment options. He was recently diagnosed with chronic HCV when his physician ordered an HCV screening test in response to the 2012 recommendation by the Centers for Disease Control and Prevention that all individuals born between 1945 and 1965 be tested for HCV, regardless of other risk factors.10 He likely acquired the infection approximately 30 years ago from a blood transfusion while in the military. His past medical history includes arthritis, hyperlipidemia, and diabetes, treated with ibuprofen, atorvastatin, and metformin, respectively. He is currently retired but travels extensively with his wife to visit their grandchildren. Follow-up HCV testing showed genotype-1b infection and a viral load of 6.2 million copies/mL. An imaging study and ultrasound of his liver demonstrated a nodular liver with mild splenomegaly. Endoscopy demonstrated small esophageal varices. Blood work showed a hemoglobin level of 13.2 g/dL, a platelet count of 108,000/mm3, an aspartate aminotransferase of 94 IU/L, and an alanine aminotransferase of 79 IU/L. Physical examination was normal. His blood pressure was 128/70 mmHg, respirations 16. There was no hepatomegaly or splenomegaly. He had mild central obesity (94 kg), no muscle wasting, and no palmar erythema.

Published on April 23, 2014

P. Kwo, MD

Hepatitis C — HCV Case Study: Interferon-Free Oral Anti-HCV Therapy in an Infected Genotype 1a-Infected Patient with Prior Null Response to Peginterferon/Ribavirin Combination Therapy – Case Study

Phase II data from emerging all-oral direct-acting antiviral regimens show high rates of sustained virologic response (SVR), even in patients with prior null response to peginterferon-based therapy. Join Paul Y. Kwo, MD, for this case study in which he identifies a null responder who elects to enroll in a phase III trial of an interferon-free regimen that includes more than one drug class. In addition, Dr. Kwo provides preliminary SVR12 data for multiple emerging regimens in this hard-to-treat patient population.

Case Presentation - Patient Assessment 

A 50-year-old male presents to your practice to discuss the potential of starting treatment for genotype-1a HCV infection. In 2009 he had a null response to peginterferon/ribavirin, with his viral load dropping only 1 log at 12 weeks, from 10 million IU/mL pretreatment to 1.2 million IU/mL. His baseline liver biopsy at that time showed stage 2 fibrosis. He reported missing no doses but found the therapy difficult to tolerate. He experienced fatigue and increasingly painful injection-site reactions. Most importantly, he found it difficult to concentrate at his full-time job as a contractor and had to turn over major projects to his partner. He feels reasonably well now, with only occasional right upper quadrant pain. He takes lisinopril 20 mg for hypertension and ibuprofen 800 mg on an as-needed basis. On physical exam he is a slightly overweight male, with a weight of 120 kg. His vitals are otherwise stable with blood pressure of 130/88 mmHg. Other than mild hepatomegaly, his exam is normal. Laboratory tests show: hemoglobin14 g/dL, platelet count of 169,000/mm3, aspartate aminotransferase 112 U/L, alanine aminotransferase 115 U/L, total bilirubin 1.2 mg/dL. His Fibroscan® demonstrates liver stiffness of 12 kPa. An ultrasound shows mild hepatomegaly and fatty infiltration, with mild splenomegaly.

Published on March 31, 2014 

I. Jacobson, MD

Hepatitis C — Hepatitis C Treatment Goes Viral: Let's Talk About Oral Therapies – Satellite Symposium 

Register today! Join us at this compelling satellite symposium for informative and interactive expert-guided presentations on the current state of oral therapies for chronic hepatitis C virus (HCV) infection, the implications of clinical trial results, and how the latest advances are affecting today’s real-world clinical practice.

This program is not affiliated with Digestive Disease Week^®. 

In Case You Missed It 

Advances in Chronic Hepatitis C Management and Treatment - EASL 1.5-hour Internet symposium 

ViralEd just released an 1.5-hour Internet symposium discussing key data presented at the 49th Annual Meeting of the European Association for the Study of the Liver (49th EASL) which took place this month in London, England.