Ineffective Absorption? Failure of Direct-Acting Therapy for Chronic Hepatitis C in Cirrhotic Patients With Roux-en-Y Gastric Bypass

J Investig Med High Impact Case Rep. Jan-Dec 2019;7:2324709619858127. doi: 10.1177/2324709619858127.

Abstract

In this era of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection, treated patients have extremely high rates of sustained virologic response to short courses of therapy regardless of stage of fibrosis. Treatment failure is uncommon and often attributed to medication noncompliance or viral resistance to drug. This report describes 2 Child-Pugh-A cirrhotic patients who failed to clear HCV in response to therapy with DAAs. Each patient had Roux-en-Y gastric bypass (RYGB) surgery preceding DAA therapy. RYGB may create multiple barriers to adequate DAA absorption as a result of changes in gastrointestinal physiology. Treatment monitoring and duration should be carefully considered in this unique patient population.

Keywords: Roux-en-Y; cirrhosis; direct-acting antiviral; gastric bypass; hepatitis C virus.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / pharmacokinetics
  • Antiviral Agents / therapeutic use*
  • Female
  • Gastric Bypass / adverse effects
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / virology
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / surgery
  • Male
  • Middle Aged
  • Sustained Virologic Response
  • Treatment Failure

Substances

  • Antiviral Agents