Treatments for hepatitis C are now well tolerated with very high rates of sustained virological response and almost all patients have a suitable and effective treatment option. However, treatment options remain limited for a minority of patients and are limited for patients with Child-Pugh B or C cirrhosis due to the risk of decompensation with protease inhibitors. We present a case of successful treatment with glecaprevir/pibrentasvir (Maviret) and sofosbuvir in a patient with Child-Pugh B cirrhosis and resistant virus who had failed three previous attempts of treatment including two courses of direct acting antiviral agents and in whom liver transplantation was deemed unsuitable. We propose that the balance of risks favours a trial of treatment with protease inhibitors in some circumstances in patients with Child-Pugh B cirrhosis where no other suitable alternatives including treatment post liver transplantation are available/appropriate.
- hepatitis and other GI infections
- hepatitis C
- drugs: infectious diseases
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Contributors All authors contributed to the manuscript. MI is the first author. He wrote the original report and co-ordinated responses from other authors to produce the final version. RO, SN and BH reviewed and contributed to the case report. BH is the senior author who prompted the writing of the case report and provided guidance on the direction/main message of the report.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BH has received unrestricted educational grants, payments for advisory boards and payments for presentations from Jannen, Gilead, BMS, Abbvie and Merck in relation to hepatitis C products. He has also received funding from Gilead, Merck, Abbvie and BMS for running meetings in relation to hepatitis C in Wales. He has secured unrestricted funding from Abbvie, Merck and Gilead for project work related to management of hepatitis C. All his disclosures are visible. None of the other authors have any conflicts of interest.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.