A 28-year-old male diagnosed with CF who had severe pancreatic and pulmonary involvement (estimated dilatation in the first second), proposed FEV1/FVC ratio of 92% at baseline, forced vital capacity (FVC) 99%, FEV1/FVC ratio 55%;
Chronic hepatitis C virus type 1b, viremia 1,58e7 IU/ml was detected during the evaluation.
Laboratory tests showed a normal blood count with prothrombin activity of 10 and the following hepatic profile: albumin transferase (AST): 96 IU/L, alkaline phosphatase (ALT12)
A liver biopsy showed tissue with cystic fibrosis lesions where the marked portal involvement by it prevented assessing HCV lesions.
No other causes of liver disease were detected.
In the multiple analytical controls performed so far there was no suspicion of liver disease except a slight occasional elevation of GGT.
Treatment was initiated with ursodeoxycholic acid (900 mg/d).
In a first evaluation at the referral unit, the option for lung transplantation due to HCV infection was rejected.
Because of this fact, it was decided to start treatment with pegylated interferon alfa-2b usual mcg/sem) and ribavirin (1,000 mg/d) for 48 weeks, presenting side effects such as asthenia, anorexia and weight loss.
There were no significant anemia or neutropenia, which required changing the doses prescribed or using hematopoietic growth factors ( Hb 12.9 g/dL, neutrophils 1800/mL).
Nadir: Hb 11.2 g/dL [10 week], neutrophils 1.060/mL [22 week].
A monthly monitoring of treatment (first visit at 15 days) was initially performed.
However, from the fourth week of treatment and until the end of it, she required 8 hospital admissions for sudden deterioration of respiratory function, so part of the monitoring was performed during hospitalization.
In the last patient, receiving oxygen at the eighth month of antiviral treatment, the following parameters were observed: FEVp mmHg, bronchodilator pressure 30%, FVC 67%, FEV1/FVC 38%, arterial pH 7.21.
Previously to the treatment, she had required several hospitalizations for respiratory exacerbations, specifically four in the previous year, with the germs isolated H influenzae and methicillin-susceptible S. aureus INFoxype.
Specific antibiotic treatment was established based on the antibiogram accompanied by the rest of the usual therapy, which improved slightly the respiratory function.
Antiviral treatment achieved early virological responses and at the end of treatment (HCV RNA undetectable by PCR at weeks 12 and 48, respectively).
Although the candidate presented treatment due to pulmonary function improvement (FEV1 43%, VPC 82%, FEV1/FVC 44%, SO2 92%) at the sixth month post-treatment, she decided to again present deterioration of the transplant data.
At that time, HCV RNA remained undetectable (SVR), so it was finally included in the TP list.
