Antiviral therapy of HCV-cirrhosis: case of sequential treatment and review of literature

This clinical case demonstrates a history of 40-year old male with decompensated liver cirrhosis due to hepatitis C (genotype 1). The patient was started on direct acting antiviral therapy with sofosbuvir and simeprevir in order to decrease rate of disease progression. Treatment was associated with marked improvement of patient’s condition and resolving of ascites. Negative viremia was achieved after week 8 of antiviral therapy and the treatment was completed on week 12. However, evaluation on post-treatment week 12 has demonstrated recurrence of hepatitis C virus with sharp increase of liver transaminases of higher than 20 times upper limit normal. Second round of direct acting antiviral agents including ombitasvir, paritaprevir, dasabuvir and ritonavir was started. Negative viremia was achieved on week 4 with consequent demonstration of end of treatment and sustained virological response at 12 weeks post-treatment. This clinical case demonstrates need for personalized approach to antiviral therapy in each patient with modification of the treatment regimen by prolongation or implementing additional antiviral agent, if needed.