title: Hyperbilirubinemia without Transaminitis during Combined Therapy with Daclatasvir and Asunaprevir.
abstract: Daclatasvir (DCV) and asunaprevir (ASV) are direct-acting antivirals (DAAs) used in the treatment of chronic hepatitis C virus (HCV) infection. Combined therapy with DCV and ASV shows high efficacy and safety even in patients with cirrhosis. We encountered a patient exhibiting severe hyperbilirubinemia during combined therapy, which is an unreported side effect of DCV and ASV. A 78-year-old woman with cirrhosis developed hyperbilirubinemia >10 mg/dl without transaminitis 3 weeks after starting combined therapy. We suspected DAAs-induced liver disorder and discontinued treatment, which resulted in the improvement of hyperbilirubinemia. Caution is required in the use of DAAs for patients with advanced cirrhosis.
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan; Department of Education and Clinical Training, Toyama University Hospital, Toyama, Japan.
authors: Hayato
authors: H
authors: Baba
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors: Kazuto
authors: K
authors: Tajiri
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors: Kohei
authors: K
authors: Nagata
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors: Kengo
authors: K
authors: Kawai
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors: Masami
authors: M
authors: Minemura
authors: The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
authors: Toshiro
authors: T
authors: Sugiyama
keywords: Cirrhosis; Direct-acting agent; Hepatitis C virus; Hyperbilirubinemia; P-glycoprotein