Navarrete Castro R
Introduction: Hepatitis C virus infection is considered a public health problem in the world. In Mexico, the estimated seroprevalence ranges from 2 to 6%. One problem has been resistance to antivirals for over a decade. But recently resistance to new molecules has been identified, which should be considered a health emergency.
Objective: To report the muti-drug resistance of new antiviral molecules in the treatment of liver virus C, genotype 1a, in a Mexican patient.
Study design: A study model was designed, applied to the case study, according to the levels of scientific evidence.
Methodology: The clinical case study was developed, according to good clinical practice. Diagnosis was established with molecular criteria, clinical monitoring and molecular studies to monitor response at the end of treatment, and sustained response and monitoring of side effects. Determination of resistance tests to the new antiviral molecules was carried out to determine a new specific antiviral treatment.
Results: 67-year-old female, originally from Mexico City, with the presence of rheumatoid arthritis, interstitial lung disease, under treatment with predisone (10 mg). On March 18, 2018, he attended an infectious assessment for presenting positive serology for liver virus C. Where infection with liver virus C was demonstrated, with quantitative PCR determination that showed a viral load of 36,824 copies / ml, and genotype 1a. laboratories: erythrocytes 4.84 10 (6) / ul, Hb 14.2g / dl, hematocrit 43%, VCM 88.7 fl, CHCM 33.1 g / dl, platelets 145 mmol / ml, leukocytes 6100 cel / ml, neutrophils 3,100 cel / ml, lymphocytes 2,100 cel / ml, eosinophils 200 cel / ml, glucose 89 mg / dl, cr 0.75 mg / dl, urea 30 mg / dl, uric acid 4.0mg / dl, sodium 140 mmol / l, potassium 4.4 mmol / l, protein 7.47 g / dl, total bilirubin o.42mg / dl, indirect bilirubin 0.12 mg / dl, direct bilirubin 0.30 mg / dl, AST 42 u / L, ALT 52 u / L, HDL 287U / L. IRON M82 NG / L., Rheumatoid Factor 202 iu / ML, C-reactive protein 0.13 mg / dl, beta -2 glycoprotein 0.25 IU / l, CCP <0.8 ng / l, anti-DNA 3.4 IU / l, anti-cardiolipin 1.4 ng / l. liver ultrasound: normal: Empirical treatment with Elbasivir and grazoprevir was given for 12 weeks, with viral load at the end of the undetectable treatment, establishing response criteria at the end of the treatment. At 6 months post-treatment, the viral load was 3,659, 284 copies / ml, so it was considered reactivation due to possible resistance. Sensitivity tests were performed, identifying Q30R, L31M mutations, with resistance to: simeprevir, Grazoprevir related to mutations of the NS3 protein and resistance to Daclatasvir, ledispavir, Elbasvir associated with mutations of the NS5a protein. He only showed sensitivity to Velpatasvir and paritapravir, Considering them as specific treatment, which guarantees a response to the treatment, with undetectable viral load at the end of treatment.
Conclusion: In the Mexican population, there is multi-drug resistance to new molecules that are an option for treatment for liver virus, but it is essential to carry out resistance tests before choosing treatment.
