Hepatitis C Treatment with Sofosbuvir and Daclatasvir in an 83 Year Old Patient with Ischemic Vasculitis and End Stage Renal Disease on Hemodialysis

Abstract

Hepatitis C virus (HCV) was first identified just over 25 years ago, but in this timeframe we have moved from identifying the virus to being able to offer a cure for the infection, which represents a remarkable feat in clinical and scientific medicine. However, the path to today’s treatment regimens was not straightforward. Interferon (INF), followed by the co-administration of ribavirin and subsequently the pegylation of IFN represented the limited standard of care for many years; notable primarily for the significant systemic effects associated with IFN based therapy. The emergence of all-oral, IFN-free regimens with second generation direct acting antivirals (DAAs) in 2013 has revolutionized the hepatitis C treatment landscape with cure rates now exceeding 90% and significantly fewer side effects. Nevertheless, there remain difficult to treat cohorts, including those with end-stage renal disease (ESRD). Limited data exists on the optimal management of such individuals with DAAs; the current report presents the case of an 83-year-old female patient with refractory ischemic vasculitis and ESRD on hemodialysis with multiple other co-morbidities successfully treated with a 12- week combination of Sofosbuvir and Daclatasvir.