Hepatitis C virus cures after direct acting antiviral-related drug-induced liver injury: Case report

Yaakov Hasin, Shimon Shteingart, Inna Gafanovich, Ilana Dery, Yoav Luria, Liver Unit, Harel Dahari, Susan L. Uprichard, Scott J. Cotler, Sharon Floru, Marius Braun, Amir Shlomai, Anthony Verstandig

Research output: Contribution to journalArticlepeer-review


The United States Food and Drug Administration recently warned that the direct acting antiviral (DAA) combination hepatitis C virus (HCV) treatment of Paritaprevir, Ombitasvir, Dasabuvir, Ritonavir, and Ribavirin (PODr + R) can cause severe liver injury in patients with advanced liver disease. Drug induced liver injury was observed in a small number of patients with decompensated cirrhosis treated with other DAAs, but has not been reported in patients with compensated cirrhosis. We report a case of a 74-year-old woman with chronic HCV and Child-Pugh class A cirrhosis (compensated cirrhosis) treated with PODr + R. The patient presented on day 14 of PODr + R therapy with jaundice and new-onset ascites. Her total bilirubin level increased to 23 mg/dL and international normalized ratio rose to 1.65, while aminotransferase levels remained relatively stable. Hepatitis C treatment was discontinued on day 24 and she gradually recovered. Follow-up testing showed that she achieved a sustained virologic response. In conclusion, hepatic decompensation developed within two weeks of starting treatment with PODr + R in a patient with Child-Pugh class A cirrhosis and was characterized by jaundice and ascites with stable aminotransferase levels. Careful monitoring is warranted in patients with HCV-related cirrhosis treated with PODr + R.

Original languageEnglish
Pages (from-to)858-862
Number of pages5
JournalWorld Journal of Hepatology
Issue number20
StatePublished - 18 Jul 2016
Externally publishedYes


  • Direct antiviral agent
  • Drug-induced liver injury
  • Hepatitis C
  • Mathematical modeling
  • Sustained virological response
  • Viral kinetics


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