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

*Corresponding author for this work

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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