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Article 21, 4/2016

CASE REPORT

A Case of Acute Liver Failure during Ritonavir-Boosted Paritaprevir, Ombitasvir and Dasabuvir Therapy in a Patient with HCV Genotype 1b Cirrhosis

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Marco Masetti, Donatella Magalotti, Elena Martino, Pietro Andreone, Alessandra Scuteri, Marco Zoli
Department of Medical and Surgical Sciences,University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.254.tti

ABSTRACT
Background: Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir plus Ribavirin is one of the current recommended therapies for HCV genotype 1b monoinfected patients in compensated (Child-Pugh A) cirrhosis. Whether it is known that the worsening of liver function is a rare but possible complication of Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir therapy, to our knowledge no description of treatment-related acute liver failure is available in the literature.

Case presentation: An 84-year-old Caucasian man with chronic compensated HCV genotype 1b cirrhosis received Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir plus Ribavirin therapy. After 13 days he developed grade 4 hyperbilirubinaemia and ascites. Even though treatment was promptly stopped, patient’s clinical condition worsened, and he underwent hospitalization, several paracentheses, and developed sub-acute kidney injury. The bilirubinemia returned under three times the upper normal limit only after five months. Notably, he achieved sustained virological response despite the very short duration of therapy.

Conclusion: Hepatic decompensation and acute liver failure are rare but severe complications of Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir plus Ribavirin therapy in patients with compensated cirrhosis. Close monitoring for signs or symptoms of worsening of liver disease is mandatory, and further research for stratifying risk factors are required.

Key words: Ritonavir – Paritaprevir – Ombitasvir – Dasabuvir – liver failure – chronic hepatitis C – adverse drug event.

Abbreviations: 3D: Ritonavir-boosted Paritaprevir, Ombitasvir and Dasabuvir; AKI: Acute Kidney Injury; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration; GGT: gamma-glutamyl transpeptidase; GT1b: Genotype 1b; HCV: Hepatitis C Virus; INR: International Normalized Ratio; MELD: Model for End-Stage Liver Disease; RBV: Ribavirin; UNL: Upper Normal Limit.