Ledipasvir/sofosbuvir

Abstract

Pulmonary arterial hypertension: case report A 36-year-old-woman developed pulmonary arterial hypertension during treatment with ledipasvir/sofosbuvir for hepatitis C virus (HCV). The woman presented with a 1-month history of dyspnoea on exertion without evidence of an active infection or acute cardiac event. Her medical history was significant congenital HIV and HCV. She had been receiving unspecified antiretroviral from the age of 2 years. Her CT pulmonary angiogram showed an enlarged main pulmonary artery and right atrial dilatation. Her transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction of 45%, right ventricular systolic dysfunction, right ventricular systolic pressure of 82mm Hg and severe tricuspid regurgitation. Subsequently, she was diagnosed with active HCV genotype 1a. Later, her TTE demonstrates right ventricular systolic pressure (RVSP) was 29mm Hg. Subsequently, she completed 12 weeks of treatment with ledipasvir/sofosbuvir [Harvoni; route and dosage not stated] for HCV and achieved sustained virologic response. However, she developed dyspnoea exertion, which prompted the workup for pulmonary arterial hypertension. Her pulmonary function testing showed FEV1 was 1.85L, forced vital capacity (FVC) was 2.38L, FEV1/FVC was 78%, total lung capacity (TLC) was 4.21L and diffusing capacity for carbon monoxide (DLCO) was 70%. Also, her right heart catheterisation revealed right atrial pressure of 6, pulmonary artery pressure of 73/33, pulmonary capillary wedge pressure was 15, a cardiac index was 1.6 L/min/m2 and pulmonary vascular resistance was 15.5 Wood units. Therefore, she was diagnosed with pulmonary arterial hypertension. The woman started receiving treatment with sildenafil, which resulted in improvement of functional capacity. Three months later, repeated TTE showed an RVSP of 57mm Hg.