Precipitating Factors Causing Hyperbilirubinemia During Chronic Hepatitis C Treatment With Paritaprevir/Ritonavir/Ombitasvir And Dasabuvir

Background:Hepatic decompensation is a fatal on-treatment side effect during chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD). Prompt bilirubin testing can reveal hepatic failure in susceptible patients, and clinical parameters precipitating early elevation of bilirubin can warn clinicians to avoid PrOD prescription.Methods:This retrospective study included 169 Hepatitis C virus (HCV)-genotype 1b patients who underwent a 12-week course of PrOD with or without ribavirin. Laboratory data underwent chi(2) analysis with Fisher's exact test to determine the precipitating factors causing hyperbilirubinemia in patients who had received 1 week of treatment.Results:Sustained viral response was achieved in 164 patients (97.0%). Total bilirubin was >= 2 mg/dL (21.3%) in 36 patients after 1 week of treatment. Pretreatment white blood cell (WBC) <4500/mu L and platelet <100,000/mu L correlated with total bilirubin >= 2 mg/dL (relative risk [RR]: 21.64, 95% CI: 5.23-89.64, p < 0.001) after 1 week of treatment. Pretreatment platelet >= 100 000/mu L and WBC <4500/mu L correlated with direct bilirubin >= 0.45 mg/dL (RR: 6.56, 95% CI: 1.42-30.38, p = 0.016) and indirect bilirubin >= 0.6 mg/dL (RR: 4.77, 95% CI: 1.03-22.15, p = 0.046). Pretreatment platelet <100,000/mu L with F3/F4 fibrosis correlated with first week total bilirubin >= 2 mg/dL (RR: 3.57, 95% CI: 1.35-9.09, p = 0.010).Conclusion:PrOD is an effective antiviral regimen for HCV genotype 1b patients. Total bilirubin >= 2 mg/dL after 1 week of treatment serves as an early warning of irreversible progression toward hepatic decompensation, and the current study provides a guide by which to monitor chronic hepatitis C patients undergoing PrOD treatment.