title: Hepatitis C virus cures after direct acting antiviral-related drug-induced liver injury: Case report.
abstract: The United States Food and Drug Administration recently warned that the direct acting antiviral (DAA) combination hepatitis C virus (HCV) treatment of Paritaprevir, Ombitasvir, Dasabuvir, Ritonavir, and Ribavirin (PODr + R) can cause severe liver injury in patients with advanced liver disease. Drug induced liver injury was observed in a small number of patients with decompensated cirrhosis treated with other DAAs, but has not been reported in patients with compensated cirrhosis. We report a case of a 74-year-old woman with chronic HCV and Child-Pugh class A cirrhosis (compensated cirrhosis) treated with PODr + R. The patient presented on day 14 of PODr + R therapy with jaundice and new-onset ascites. Her total bilirubin level increased to 23 mg/dL and international normalized ratio rose to 1.65, while aminotransferase levels remained relatively stable. Hepatitis C treatment was discontinued on day 24 and she gradually recovered. Follow-up testing showed that she achieved a sustained virologic response. In conclusion, hepatic decompensation developed within two weeks of starting treatment with PODr + R in a patient with Child-Pugh class A cirrhosis and was characterized by jaundice and ascites with stable aminotransferase levels. Careful monitoring is warranted in patients with HCV-related cirrhosis treated with PODr + R.
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Hasin
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Shteingart
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Harel
authors.initials: H
authors.lastname: Dahari
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Inna
authors.initials: I
authors.lastname: Gafanovich
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Floru
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Marius
authors.initials: M
authors.lastname: Braun
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Shlomai
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Anthony
authors.initials: A
authors.lastname: Verstandig
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Dery
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Uprichard
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cotler
authors.affiliation: Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Lurie
keywords: Direct antiviral agent; Drug-induced liver injury; Hepatitis C; Mathematical modeling; Sustained virological response; Viral kinetics