CASE STUDY:
Retreatment of HCV Nonresponder

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 31-year-old Indian gentleman was referred to a hepatologist by his primary care physician after a local gastroenterologist unsuccessfully treated him with peginterferon α-2b plus ribavirin. The patient was diagnosed 18 years prior with non-A non-B chronic hepatitis, and in 1998, the diagnosis was confirmed to be chronic hepatitis C with a positive hepatitis C antibody test and a HCV RNA PCR greater than 850,000 IU/mL (the superior limit of detection at that time). His genotype is 1b.

The patient received interferon α-2b, 3 MU TIW plus ribavirin 1000 mg daily for 48 weeks between August 1999 and July 2000. He was also treated with peginterferon α-2b weekly and ribavirin 1000 mg daily for 48 weeks between March 2001 and February 2002. At the end of the second course of therapy, his HCV PCR RNA was 754,000 IU/mL, and his ALT was 59 IU/L. At the time of his first visit to the hepatologist, the patient complained of heartburn and right upper quadrant abdominal pain.

PAST MEDICAL/SURGICAL HISTORY

His past medical history revealed blood transfusions at birth in India due to erythroblastosis fetalis and chronic bronchitis diagnosed in 1997.

SOCIAL HISTORY

The patient is married with 1 daughter and denied ever having used illicit or intravenous drugs. He does not habitually drink alcohol.

MEDICATIONS/ALLERGIES

The patient takes no medications and has no known drug allergies.

PHYSICAL EXAMINATION

Vital Signs
Height	Weight	Temperature	Pulse	Blood Pressure	Respiratory Rate
5 ft. 8 in.	178 lbs.	36.7° C	80/min	110/70 mm Hg	20/min

On physical examination, a mild hepatomegaly (14 cm in the midclavicular line and 11.6 cm midsternal line) was observed. A mild jaundice was noted on sclera examination. There was no ascites, pedal edema, nor asterixis.