Rapid Progression of Chronic Hepatitis C Virus Infection Following Treatment Failure With Harvoni: A Case Report

Abstract

Patient is a 71-year-old African American male with medical history of hepatitis C virus infection S/P failed Harvoni therapy, hypertension, diabetes mellitus type II, chronic kidney disease stage IV, nicotine dependence and marijuana use. Was diagnosed of HCV infection about 16 years prior treatment was initiated. Treatment for Hepatitis C with Harvoni was started on (2/20/16) and completed 12 week course treatment with about 96% compliance. Following treatment patient HCV viral load became undetectable. 6-month post treatment HCV was detected with associated NS5A drug resistance. Patient remained asymptomatic except for fatigue that started during Harvoni treatment. Patient presented to the emergency department with pain was described has dull, located in the epigastric area, non-radiating, no known aggravating factor, relieved with pain medications, associated with loss of appetite, weight loss and constipation. On examination patient was cachetic, jaundiced, no asterixis, normal cardiovascular and decrease breath sounds in the lower lung zones worse on the right, tender hepatomegaly. Laboratory test result include Hepatitis C genotype 1a, fibrosis score 0.41, F, fibrosis stage F1-F2, necroinflammation A1-A2, Alpha 2-Macroglobulins 370mg/dL(high). Resistance test showed no RAV (Resistance associated variant) for NS5B but possible RAV to NS5A1. Hepatitis Be core Ab Positive, Hepatitis B surface Ab non-reactive, Hep A ab Neg, AFB Serum, Tumor Marker (3.3ng/Ml). CT abdomen pelvis showed heterogeneous liver mass with portal vein tumor thrombus, favoring hepatocellular carcinoma. Patient underwent Liver and lung biopsy which confirmed Hepatocellular carcinoma and squamous cell carcinoma of the lungs. Patient was started on palliative radiotherapy but died; primary cause of death respiratory failure and sepsis. Various factors have been associated with chronicity and probably progression to liver cirrhosis and hepatocellular cancer. Progression is variable with no linear relationship. Risk factors include old age, male gender, coinfection with hepatitis B, metabolic factor (obesity, insulin resistance, steatosis), use of alcohol, use of Marijuana, use of coffee and HCV genotype 3A. Other risk factors include duration of disease and being of African American descent. Studies have shown higher SVR, as high has 99% to 100% in patients treated for 24 weeks. Patients with multiple risk factors are likely to benefit from longer course of treatment.Figure