Department of Internal Medicine, Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Case Rep. 2020 Jun 4;21:e923326. doi: 10.12659/AJCR.923326.
BACKGROUND Short-course hepatitis C (HCV) treatment with direct-acting antivirals (DAA) under 8 weeks in duration has resulted in variable efficacy rates in HCV mono-infection. Further, DAA courses under 8 weeks in duration have not been studied in HIV/HCV co-infection. We present a case report of 12-week sustained virologic suppression after treatment interruption of ledipasvir/sofosbuvir at 4 weeks in a patient with HIV/HCV co-infection. CASE REPORT A 28-year-old male patient diagnosed with well-controlled HIV infection and HCV co-infection (treatment-naïve, genotype 1a, unknown hepatic fibrosis) started a 12-week course of ledipasvir/sofosbuvir (LDV/SOF) for HCV treatment. The patient completed only 4 weeks of LDV/SOF before returning for follow-up 7 weeks after initiation. Ledipasvir/sofosbuvir treatment was discontinued. Sustained virologic suppression at 12 weeks was observed after completion of a short, 4-week course of LDV/SOF. CONCLUSIONS Compared to currently recommended treatment durations, clinical trials of short-course DAA treatments of less than 8 weeks have not demonstrated successful rates of SVR12. However, in cases of DAA interruption or incomplete treatment, clinicians may choose to assess for SVR12 prior to continuing or restarting the full treatment course.
在持续 8 周以内的疗程中使用直接作用抗病毒药物（DAA）治疗短程丙型肝炎（HCV），在 HCV 单感染患者中产生了不同的疗效。此外，在 HIV/HCV 合并感染患者中，未对持续 8 周以内的 DAA 疗程进行研究。我们报告了一例 HIV/HCV 合并感染患者在接受 ledipasvir/sofosbuvir 治疗 4 周后中断治疗，12 周时持续病毒学应答的病例。
一名 28 岁男性患者，患有经良好控制的 HIV 感染和 HCV 合并感染（初治、基因 1a 型、未知肝纤维化），开始接受 12 周 ledipasvir/sofosbuvir（LDV/SOF）治疗 HCV。患者在开始治疗 7 周后，仅完成了 4 周的 LDV/SOF 就返回进行随访。停止了 LDV/SOF 治疗。在完成 4 周的 LDV/SOF 短疗程治疗后，观察到 12 周时持续病毒学应答。
与目前推荐的治疗持续时间相比，8 周以内的 DAA 短疗程治疗的临床试验并未显示出 SVR12 的成功率。然而，在 DAA 中断或治疗不完整的情况下，临床医生可能会选择在继续或重新开始完整疗程之前评估 SVR12。
