A 57-year-old man with a 10-year history of hepatitis C is enrolled in a treatment study. After
commencing treatment, his laboratory results are as follows:
Total bilirubin: 3.3 mg/dL (normal range: <1.2)
Direct bilirubin: 0.2 mg/dL (NR: < 0.3)
Reticulocyte count: 9.1% (NR: 0.5-2.5)
Hematocrit: 38.5% (male NR: 40-54)
Which of the following is the most likely causative agent?
- A) Ritonavir
- B) Entecavir
- C) Glecaprevir
- D) Sofosbuvir
- E) Ribavirin
0 voters
EXP:
The answer is E.
Ribavirin, an RNA polymerase inhibitor that may be used in the treatment of hepatitis C, can cause
hemolytic anemia.1, 2, 3
This is evidenced by this patient’s elevated indirect bilirubin (i.e., an increase in total without an
increase in direct) and reticulocyte count.
Ritonavir is a protease inhibitor used in the treatment of HIV. Because it is a P-450-inhibitor, it is
sometimes used as a “booster” agent to maintain serum levels of other drugs. It has been trialed in
hepatitis C regimens for this reason.4 However it is not associated with hemolysis.5
Entecavir is a DNA polymerase inhibitor used in the treatment of hepatitis B.6, 7
Glecaprevir is a hepatitis C NS3/4A protease inhibitor.8 Hemolysis may be seen if combined with
ribavirin.9
Sofosbuvir is a hepatitis C NS5B nucleotide polymerase inhibitor.10 Hemolysis may be seen if
combined with ribavirin