ABSTRACT
A 70-year-old woman with hepatitis C cirrhosis underwent balloon-occluded retrograde transvenous obliteration for hepatic encephalopathy due to spleno-renal shunt. Because the shunt was thick, long, and winding, we used a coaxial and double interruption system, which enables the effective occlusion of the drainage route, and shape-memory coils, which are more physically stable than conventional metallic coils because they form three-dimensional loops. The patient was successfully treated with the combined usage of these devices, resulting in a normal serum ammonia level. Thereafter, the patient was treated with direct-acting antivirals, and a sustained virological response was achieved.
Subject(s)
Antiviral Agents/therapeutic use , Hepatic Encephalopathy/etiology , Hepatitis C/complications , Hepatitis C/drug therapy , Kidney/surgery , Liver Cirrhosis/complications , Spleen/surgery , Aged , Balloon Occlusion/methods , Female , Hepatitis C/surgery , Humans , Liver Cirrhosis/surgery , Splenorenal Shunt, Surgical/methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To review the updated research on direct antiviral agents (DAAs)-including regimens for hepatitis C virus (HCV), and focus on "difficult-to-treat" HCV-infected patients.</p><p><b>DATA SOURCES</b>The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July 2013.</p><p><b>STUDY SELECTION</b>Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and reviewed.</p><p><b>RESULTS</b>It was recognized that some "difficult-to-treat" patients would still exist, even though stronger treatments using such as DAAs, including telaprevir and boceprevir, which lead to higher sustained virological response rates, are available. Such patients include those with advanced fibrosis/cirrhosis, elderly persons, children, HCV-human immunodeficiency virus co-infected patients, HCV-infected recipients, and so on.</p><p><b>CONCLUSIONS</b>Certain "difficult-to-treat" patients would still exist, even though stronger treatment is available. Although evidence from clinical trials is still lacking, interferon-sparing regimens could have stronger effects for eradicating HCV in such cases.</p>
