Kleppinger Erika L, Ragan Addison P
Department of Pharmacy Practice, Harrison School of Pharmacy, Harrison School of Pharmacy, Auburn University, Auburn, AL 36849, USA.
Am J Health Syst Pharm. 2009 Mar 1;66(5):465-8. doi: 10.2146/ajhp080243.
The case of a patient with hepatitis C who developed elevated hepatic transaminase levels associated with the use of interferon alfacon-1 and ribavirin is described.
A 55-year-old Caucasian man arrived at a hepatitis C clinic to discuss alternative treatment options for his hepatitis C virus (genotype 1a) infection, which did not respond to a 48-week course of peginterferon and ribavirin therapy. He was subsequently treated with interferon alfacon-1 9 microg subcutaneously daily plus ribavirin 200 mg orally twice daily. During treatment with interferon alfacon-1, he developed elevated hepatic transaminase levels despite a decrease in viral load. His hepatic transaminase levels returned to baseline when interferon alfacon-1 was discontinued and rose again upon rechallenge. Ribavirin was not the likely cause of the increase in transaminases since the patient previously tolerated it in combination with peginterferon. While activation of autoimmune hepatitis is a potential cause of acute decompensation in patients treated with interferons, it was not believed to be the case in this patient. Interferon alfacon-1 was determined to be the probable cause of the rise in hepatic transaminase levels in this patient, since his levels declined when therapy was discontinued and rose dramatically once it was restarted. This case illustrates the importance of monitoring both viral loads and hepatic transaminase levels in patients with hepatitis C being treated with interferon therapy.
A patient with hepatitis C developed elevated hepatic transaminase levels despite showing an improvement in viral load after receiving interferon alfacon-1 and ribavirin.
描述1例丙型肝炎患者在使用干扰素 alfacon-1 和利巴韦林后出现肝转氨酶水平升高的病例。
一名55岁的白种男性前往丙型肝炎诊所，讨论其丙型肝炎病毒（基因型1a）感染的替代治疗方案，该患者对聚乙二醇干扰素和利巴韦林治疗48周无反应。随后，他接受了皮下注射干扰素 alfacon-1 每日9微克加口服利巴韦林每日200毫克，分两次服用的治疗。在使用干扰素 alfacon-1 治疗期间，尽管病毒载量下降，但他的肝转氨酶水平仍升高。停用干扰素 alfacon-1 后，其肝转氨酶水平恢复至基线，再次用药时又升高。由于该患者之前能耐受聚乙二醇干扰素联合利巴韦林，因此利巴韦林不太可能是转氨酶升高的原因。虽然自身免疫性肝炎的激活是接受干扰素治疗患者急性失代偿的潜在原因，但该患者并非如此。由于停药后患者的转氨酶水平下降，而重新用药后又大幅升高，因此确定干扰素 alfacon-1 是该患者肝转氨酶水平升高的可能原因。该病例说明了在接受干扰素治疗的丙型肝炎患者中监测病毒载量和肝转氨酶水平的重要性。
1例丙型肝炎患者在接受干扰素 alfacon-1 和利巴韦林治疗后，尽管病毒载量有所改善，但肝转氨酶水平仍升高。
