A 55 year old gentleman with genotype 1 b chronic hepatitis C diagnosed 10 years ago, a history of depression (complicated by psychosis in the past), and hypertension, sees you in clinic asking about his hepatitis C treatment options. He was never offered interferon therapy because of his history of depression/psychosis, but now that the new direct acting antivirals are available he was wondering if he should get treated, and how urgently this needs to be pursed. He has no insurance and is currently unemployed.
His hepatitis C is thought to be acquired through IV heroin abuse 15 years ago. He since then went through a rehabilitation program and has been "clean" for 14 years. He is an active smoker (15 pack years), he drinks socially (2-3 beers weekly).
Review of systems is negative.
- Sertraline 50 mg daily
- Amlodipine 5 mg daily
His physical exam is unremarkable, his weight is 165 lbs (75kg), and height is 5’11’’ (179 cm), BMI 23.7.
His last set of labs a month prior to presentation:
• Hepatitis B Surface Antibody positive, surface antigen negative, core antibody negative
• HIV antibody negative.
• Sodium= 138 mmol/L
• Potassium= 4 mmol/L
• Chloride= 102 mmol/L
• CO2= 25 mmol/L
• Creatinine- 0.9 m/dL
• BUN= 12 mg/dL
• Glucose= 110 mg/dL
• AST= 33 U/L (Normal range 15-41)
• ALT= 35 U/L (Normal range 17-63)
• Alkaline phosphatase= 92 U/L
• Total Bilirubin= 0.8 mg/dL
• Total protein= 6 g/dL
• WBC= 6 x 10^9 d/L
• Hemoglobin= 13.5 g/dL
• Platelet count= 201 x 10^9/L
• INR= 1.0
• Hepatitis C viral load: 2,230,000 IU/ml.
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