Possible Simeprevir/Sofosbuvir-Induced Hepatic Decompensation With Acute Kidney Failure

Area of Science:

• Hepatology
• Nephrology
• Pharmacology

Background:

• Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis C virus (HCV) infection.
• Direct-acting antiviral (DAA) regimens, including simeprevir and sofosbuvir, are highly effective for HCV treatment.
• Patients with HCC may have underlying liver dysfunction, increasing risks for adverse events.

Purpose of the Study:

• To report a case of significant hyperbilirubinemia and acute kidney injury (AKI) in a patient with HCV and HCC.
• To highlight potential drug-induced toxicities associated with simeprevir and sofosbuvir therapy in this patient population.

Main Methods:

• Case report detailing clinical presentation, laboratory findings, and treatment course.
• Review of patient's medical history, including hepatitis C infection and hepatocellular carcinoma.
• Monitoring of liver function tests and renal function following initiation of antiviral therapy.

Main Results:

• The patient developed severe hyperbilirubinemia (elevated bilirubin levels).
• Significant acute kidney injury was observed after starting the simeprevir and sofosbuvir regimen.
• These adverse events occurred in the context of pre-existing liver disease and cancer.

Conclusions:

• The combination of simeprevir and sofosbuvir may be associated with serious adverse events, including hyperbilirubinemia and AKI, in patients with advanced liver disease and HCC.
• Careful monitoring is crucial for patients with hepatitis C and hepatocellular carcinoma receiving DAA therapy.
• Further investigation into the safety profile of DAAs in complex liver disease patients is warranted.