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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify and evaluate the clinical manifestations and laboratory parameters relevant to the assessment and treatment of chronic hepatitis C virus (HCV) infection.

  • Design a patient-specific pharmaceutical care plan for a patient with chronic HCV, including drugs, doses, and durations of therapy.

  • Develop a plan for monitoring efficacy and adverse effects of the pharmacologic agents used in the management of HCV.

  • Identify and evaluate the drug interactions with direct-acting antiviral (DAA) agents used in HCV treatment.

  • Provide patient education for patients with chronic HCV regarding their medications, nonpharmacologic interventions/behaviors, and vaccinations.

PATIENT PRESENTATION

Chief Complaint

“About three months ago, my primary care physician told me that my liver tests were abnormal. She referred me to your liver clinic and I am here today to talk about the test results from last month.”

HPI

Mr Michael Jones is a 58-year-old African-American man who has been referred by his primary care physician to the liver clinic for assessment of his abnormal liver enzymes. His physician had screened the patient for HCV after a pop-up alert in her institution’s electronic health record system recommended it. After a referral from the primary care physician, Mr Jones presented to liver clinic 1 month ago to see the hepatologist and had a FibroScan and labs drawn. He presents today to discuss the results and next steps.

He denies ever having blood transfusion. He reports use of recreational drugs including marijuana, alcohol, IV heroin, and intranasal cocaine in his teenage years and in his 20s. He states that he stopped use of these drugs around 30 years ago. He had a tattoo placed with a coat hanger while he was in his 20s. He also has a history of heavy alcohol use since his teens. He was treated for drug and alcohol abuse 6 months ago through an inpatient treatment program, and says he has been sober since that time. He denies any jaundice or right upper quadrant pain. He also denies any hepatic encephalopathy or signs or stigmata of chronic liver disease at this time.

PMH

GERD: Began several years ago, is often exacerbated by spicy food

Right TKA in 2014, with chronic knee pain; recently discontinued naproxen due to stomach upset and was switched to tramadol by his primary care physician

Type 2 diabetes mellitus (diet-controlled now; glargine insulin was discontinued after HgbA1c was 5% last year)

FH

No known family history of liver disease or hepatocellular carcinoma (HCC). Both parents are deceased (father died from prostate cancer at 76, ...

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