CASE 4 44 yo man HIV positive 2010 CD4 400 on diagnosis Initiated Abacavir/3TC/Dolutegravir in /2013 CD4 600 HIV viral load<40 Normal liver enzymes

CASE 4 FEB 2013 Acute Hepatitis C…ALT>1000 Genotype 4 HCVRNA 1.7 x 10e6

CASE 4 Remainder of 2013 ALT decreased to HCVRNA 1.02x 10e5 (may/13) to 2.1 x 10e6 (Aug 2013) Diagnosis…Chronic Hepatitis C

CASE 4 Jan-July 2014 ALT decreased to CD4 600 HIV Viral Load<40

CASE 4 AUG 2014 ALT increased to 280 CD4 600 HIV Viral Load<40

CASE 4 NOV 2014 ALT down from 280 to 80 We discussed initiating therapy with Sofosbuvir/RBV x 24 weeks

CASE 4 DEC 2014 ALT 45 Baseline HCVRNA done Initiated therapy with Sofosbuvir/RBV x 24 weeks

CASE 4 JAN 2015 Week 2 of Hep C therapy with SOF/RBV ALT 30 Retrospectively baseline HCVRNA was undetectable prior to therapy despite elevated ALT!!!

CASE 4 JAN 2015 Went back to HIV viral load bloods that were stored from August/14 and late November/14 and ran HCVRNAs

CASE 4 Jan-Feb 2015 Baseline HCVRNA in x 10 e6 Aug/14 8.2x 10e4 Nov/ x 10e1 Dec/14 (pre-Rx) undetectable

CASE 4 Feb 2015 Self clearance of Hep C 20 months post acute Hepatitis C!!! Decided to finish SOF/RBV therapy as side effect free in case there would be a rebound of HCVRNA We could have discontinued but would then only have 18 weeks of therapy left if we had to restart