Reactions 1358 - 2 Jul 2011

SPeginterferon-α-2a/ribavirin

Liver dysfunction leading to cirrhosis: casereport

A 62-year-old woman with chronic hepatitis C virus(HCV) developed liver dysfunction leading to cirrhosiswhile receiving treatment with peginterferon-α-2a andribavirin [Copegus].

The woman had previously received treatment fromNovember 2000 with interferon-β, followed by interferon-α. During this time, virus elimination was not achieved andher levels of ALT and GGT were elevated. In February 2008,due to high viral load, she was admitted for furthertreatment. She received hypodermic injections ofpeginterferon-α-2a 180µg once a week and ribavirin600 mg/day [route not stated]. After starting treatment, hertransaminase levels gradually increased above 100 IU/L.Glycyrrhizin was subsequently added to her therapy frommid-June. After 12 months of peginterferon-α-2a andribavirin, she had an AST/ALT ratio of 188/128 IU/L and anALP/GGT ratio of 480/568 IU/L. After 13 months of therapy,her serum ferritin levels were also elevated. She completed72 weeks of treatment, with her last injection administeredmid-July 2009. Her liver enzyme levels did not improveduring treatment. At the end of treatment she also hadelevated levels of serum IgG and decreased serumcreatinine. In December 2009, liver biopsy revealedfeatures of liver cirrhosis, with nodule formation andextensive cell dropout.

Five months after the completion of treatment, thewoman’s transaminase levels had normalised and herlevels of GGT and ferritin had also decreased. However,HCV RNA levels were positive and subsequent endoscopyrevealed oesophageal varices, indicating progression ofcirrhosis.Ohkoshi S, et al. A case with chronic hepatitis C who developed liver cirrhosis dueto liver dysfunction caused by pegylated interferon plus ribavirin treatment despitenegativity of serum HCV RNA, during therapy. Nippon Shokakibyo Gakkai Zasshi108: 267-274, No. 2, 15 Feb 2011 [Japanese; summarised from a translation] -Japan 803056227

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Reactions 2 Jul 2011 No. 13580114-9954/10/1358-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved