title: Elevated hepatic transaminases associated with the use of interferon alfacon-1 and ribavirin.
abstract: OBJECTIVE
  The case of a patient with hepatitis C who developed elevated hepatic transaminase levels associated with the use of interferon alfacon-1 and ribavirin is described.
  
  
  CONCLUSIONS
  A 55-year-old Caucasian man arrived at a hepatitis C clinic to discuss alternative treatment options for his hepatitis C virus (genotype 1a) infection, which did not respond to a 48-week course of peginterferon and ribavirin therapy. He was subsequently treated with interferon alfacon-1 9 microg subcutaneously daily plus ribavirin 200 mg orally twice daily. During treatment with interferon alfacon-1, he developed elevated hepatic transaminase levels despite a decrease in viral load. His hepatic transaminase levels returned to baseline when interferon alfacon-1 was discontinued and rose again upon rechallenge. Ribavirin was not the likely cause of the increase in transaminases since the patient previously tolerated it in combination with peginterferon. While activation of autoimmune hepatitis is a potential cause of acute decompensation in patients treated with interferons, it was not believed to be the case in this patient. Interferon alfacon-1 was determined to be the probable cause of the rise in hepatic transaminase levels in this patient, since his levels declined when therapy was discontinued and rose dramatically once it was restarted. This case illustrates the importance of monitoring both viral loads and hepatic transaminase levels in patients with hepatitis C being treated with interferon therapy.
  
  
  CONCLUSIONS
  A patient with hepatitis C developed elevated hepatic transaminase levels despite showing an improvement in viral load after receiving interferon alfacon-1 and ribavirin.
authors.affiliation: Department of Pharmacy Practice, Harrison School of Pharmacy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA. kleppel@auburn.edu
authors.forename: Erika L
authors.initials: EL
authors.lastname: Kleppinger
authors.forename: Addison P
authors.initials: AP
authors.lastname: Ragan
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006526:Hepatitis C / Q000188:drug therapy; D006801:Humans; D007370:Interferon Type I / Q000009:adverse effects*; D016898:Interferon-alpha; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D000637:Transaminases / Q000097:blood / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007370:Interferon Type I; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin; C050739:interferon alfacon-1; D000637:Transaminases