gpg koeln Case: HCV-Monoinfection 53 years old woman Former - PowerPoint PPT Presentation

gpg koeln

Case: HCV-Monoinfection  53 years old woman  Former injection-drug user – Has not used injection drugs for 5 yrs  Employed and has health insurance  Heterosexual but not currently sexually active  Smokes 20 packyears  Drinks alcohol occasionally  HBsAb positive, HIV-Ab negative gpg koeln

Laboratory Parameters  HCV RNA: 5.8 million IU/mL; HCV genotype 1a  IL 28: CC genotype  AST: 40 U/L (normal < 35); ALT: 35 U/L (normal < 30)  GGT: 42 U/L (normal < 40)  INR: 1.2 (normal 0.8-1.2)  Alkaline phosphatase: 75 IU/L (normal 33-131)  CBC normal except platelet count of 180,000 (normal 100,000- 450,000) gpg koeln

Clinical Information  On exam, she has small cervical lymph nodes  No ascites, edema, or stigmata of chronic liver disease  He has been compliant with all visits and is anxious to start treatment for her HCV  Liver biopsy shows grade 1 inflammation but stage 2 fibrosis without any sign of cirrhosis  Co-medication: Trimipramin 25 mg since 2 years because of reactive depression gpg koeln

HCV-Therapy  Start therapy on 28.02.2012 with PegIFN alfa-2a 180 µg/wk + Weight-Based RBV (1200 mg/day)  After 4 weeks lead-in virological response: HCV-RNA 30 IU/ml  start Boceprevir after 4 weeks Lead-in  After 8 weeks therapy : HCV-RNA <12 IU/ml  Treatment is well tolerated gpg koeln

gpg koeln

gpg koeln

 RT-PCR NS5 B Region Sequence analysis  Submit to geno2pheno[HCV] or COMET  Select Primers for NS3 in case of Genotyp 1  Sequence analysis  Submit to Geno2pheno gpg koeln