Alimohammadi Arshia, Conway Brian, Yamamoto Leo
Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
Faculty of Medicine, Univertisy of British Columbia, Vancouver, British Columbia, Canada.
BMJ Case Rep. 2020 Feb 11;13(2):e233098. doi: 10.1136/bcr-2019-233098.
Some individuals do not achieve a cure of their hepatitis C virus (HCV) infection due to non-adherence or resistance associated substitutions. Salvage options that are optimised for resistance profiles are essential. We report a 56-year-old Caucasian man with fatigue, depression and confusion in the setting of untreated HCV genotype 3a infection. He received ruzasvir and uprifosbuvir for 12 weeks within a clinical trial. The patient relapsed 4 weeks after the end of treatment and at this time resistance testing showed multiple resistances including a NS5A Y93H mutation. Given that this mutation confers resistance to first line salvage options, sofosbuvir and glecaprevir/pibrentasvir was used for 12 weeks and the patient was cured of HCV infection 12 weeks after the end of treatment. This shows that sofosbuvir and glecaprevir/pibrentasvir is a viable, effective option for second line/salvage therapy of HCV infection in the setting of resistance to NS5A inhibitors with the Y93H mutation.
由于不依从或与耐药相关的替代，一些个体未能治愈丙型肝炎病毒（HCV）感染。针对耐药谱进行优化的挽救治疗方案至关重要。我们报告一名56岁的白种男性，在未经治疗的HCV 3a型感染情况下出现疲劳、抑郁和意识模糊。他在一项临床试验中接受了鲁扎斯韦和乌普瑞司他韦治疗12周。患者在治疗结束后4周复发，此时耐药检测显示多种耐药，包括NS5A Y93H突变。鉴于该突变赋予对一线挽救治疗方案的耐药性，于是使用索磷布韦和格卡瑞韦/哌仑他韦治疗12周，患者在治疗结束后12周时HCV感染得以治愈。这表明在对具有Y93H突变的NS5A抑制剂耐药的情况下，索磷布韦和格卡瑞韦/哌仑他韦是HCV感染二线/挽救治疗可行且有效的选择。
