โ Scribed by Michael D. Leise; W. Ray Kim; Katherine M. Canterbury; John J. Poterucha
No coin nor oath required. For personal study only.
A 52-year-old asymptomatic man is evaluated for chronic hepatitis C (CHC). The aspartate aminotransferase is 138 U/L and the alanine aminotransferase is 164 U/L, with normal bilirubin, alkaline phosphatase, albumin, and complete blood counts. The international normalized ratio is 1.1 and the serum creatinine is 0.9 mg/dL. Hepatitis C virus (HCV) RNA is 1.6 million IU/mL, and genotype is 1b. The patient has read about telaprevir and wants to know whether he is a candidate for treatment with this drug. He also wants to know whether he really requires a liver biopsy prior to initiation of treatment.
Would you use telaprevir with interferon and ribavirin in this patient? How will you determine whether he is responding to the drug regimen, how long will you give the medications, and how will you monitor for side effects? How do you determine whether treatment-related anemia is related to telaprevir and not ribavirin or interferon? Which of the side effects of telaprevir would warrant discontinuation of treatment?
Would your approach be different if the patient had genotype 2, genotype 3, or genotype 4 disease? Would your approach be different if he had the CC genotype for the interleukin-28 (IL-28) polymorphism?
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