Marked Flare in Hepatic Aminotransferases During Treatment with Pegylated Interferon for Chronic Hepatitis C, Genotype 2: A Case Report

Abstract

Chronic hepatitis C (CHC) is the most common cause of chronic liver disease and is the leading cause of liver transplantation in the United States [1, 2]. It is a progressive disease that can lead to cirrhosis, liver failure, hepatocellular carcinoma, and death [1, 2]. Hence, it is very important that the disease be treated in its early stages, with the goal of obtaining sustained virologic response, which will effectively reduce the morbidity and mortality associated with this disease. The currently approved therapy for CHC is pegylated interferon plus ribavirin for 24 weeks or 48 weeks, based upon genotype [3]. The use of pegylated interferon and ribavirin combination therapy is associated with many side effects, and close monitoring of patients is required while they are on the therapy. We report an unusual case of marked flares in hepatic aminotransferases during each of two consecutive courses of pegylated interferon and ribavirin therapy for CHC genotype 2. There are very limited published data on the hepatotoxicity or liver enzyme flares associated with interferon therapy. In earlier data from a large retrospective study performed on 11,241 patients with chronic viral hepatitis (80% being CHC) treated with alfa interferon, only four patients had fatal side effects due to liver failure, and all four patients demonstrated a significant rise in aminotransferase levels [4]. It is possible that large, prospective, clinical trials may have revealed individual cases similar to our case but were not individually reported. Interferon maintenance trials, such as Hepatitis C Antiviral Long-term Treatment Against Cirrhosis (HALT-C) and Colchicine versus Peg-Intron Long-Term (COPILOT) may ultimately demonstrate transient alanine aminotransferase (ALT) flares, but these include predominantly nonresponder subjects and have not yet been published. Moreover, natural flares of serum ALT values in CHC patients are not very well-defined.