Case report of the available of interhenotypic recombinant in chronic hepatitis C: the algorithm of individualization of the antiviral therapy

In this particular case report (in vivo the persistence of HCV intergenotipic recombinant form /2/1b/ peripheral blood mononuclear cells of patient) is an example of optimizing the standard antiviral therapy (PegIntron + Rebetol). In this paper we report a patient infected by HCV 1b and, probably, recombinant 2/1b that is detected in peripheral blood mononuclear cells (PBMC). Patient S., male, 31 years old admitted in January 2009. HCV viral load in serum before treatment 9,630,000 IU/ml. HCV genotyping by sequencing 5'UTR and NS5A. According to phylogenetic analysis NS5A belongs to 1b (sera and PMBC), 5'UTR from serum to 1b, from PBMC to genotype 2. Due to discordant results recombinant 2/1b in PBMC can be suspected. NS5A interferon sensitivity determining region (ISDR) contains mutation R2218H. Laboratory: ALT 71 U/l, AST 62 U/l, GGT 36 U/l. Liver biopsy: HAI 18, fibrosis 3. Immunohistochemically HCV NS3 was detected in lobules and tracts. Elevated CD16 and CD20 was found in lymphoid follicules of portal tracts. Patient received treatment with pegintron (1.5 mg/kg BW) plus ribavirin (1000 mg/day) for 48 weeks. Virological and biochemical response were achieved on 12 wk and remained until the end of treatment and during follow-up. Liver biopsy after treatment: HAI 6, fibrosis II. Immunohistochemically NS3 was still detected in lobules and tracts, CD16 and CD20 decreased in portal tracts. We also discuss the justification of the selected option treatment strategy (reduced time-course of combination antiviral therapy /28 weeks/ and supplementation of course of antiviral therapy without interferon: a combination of interferon inducer /Cycloferon/ or antiviral drugs /Rebetol/ for another 12 weeks.