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CASE 3

CASE 3 . 63 yo man HIV positive G1a chronic Hepatitis C… Recent HIV history TDF/FTC/RTV/ Atazanavir with CD4 480 and HIV viral load<40. CASE 3 . Chronic Hepatitis C history Naïve…no secondary causes of liver disease F3 via non invasive methods

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CASE 3

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  1. CASE 3 • 63 yo man • HIV positive • G1a chronic Hepatitis C… Recent HIV history TDF/FTC/RTV/Atazanavir with CD4 480 and HIV viral load<40

  2. CASE 3 Chronic Hepatitis C history • Naïve…no secondary causes of liver disease • F3 via non invasive methods • Chooses to keep HIV meds the same and wants to try Telaprevir • Very concerned about side effects/QOL during therapy • Baseline HCVRNA 1.86 x 10e6

  3. CASE 3 Response to PEG INF/RBV/Telaprevir • Week 0 HCVRNA 1.86x10e6 • Week 4 HCVRNA Detectable but <15 • Week 8 HCVRNA <15 • Develops rash at week 8…what information would you like?

  4. CASE 3 Rash • Mild,less than 50% BSA with maculopapular component on back of arms and upper back • Intensely pruritic • No associated constitutional symptoms • No mucous membrane involvement • Any questions regarding labs?

  5. CASE 3 Labs • CBC…no eosinophilia • Liver enzymes/renal function unchanged from previous • What would you do given rash?

  6. CASE 3 Continues with PEG INF/RBV/Telaprevir as no concerning signs relating to rash • Rash associated symptoms worsen with increasing pruritis despite local therapy with a steroid cream and Benadryl…keeping him awake causing increased agitation during the days and fatigue relating to insomnia and Benadryl effect • Rash itself progresses to involve entire trunk, arms and legs to now encompass >50% body surface area (approx 65%) • No constitutional symptoms, blistering,target lesions or mucous membrane involvement

  7. CASE 3 End of week 10 of therapy with triple therapy • What would you do?

  8. CASE 3 End of week 10 of therapy with triple therapy Telaprevir discontinued and PEG INF/RBV continued • Rash progressed a little further without alarming features for a further week and symptoms continued for 2 more weeks • Do you think that we have increased risk of relapse given shorter course of Telaprevir?

  9. CASE 3 Week 12 HCVRNA <15 Week 16 HCVRNA <15 Week 24 HCVRNA <15

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