1. CASE 3 63 yo man HIV positive G1a chronic Hepatitis C… Recent HIV history TDF/FTC/RTV/Atazanavir with CD4 480 and HIV viral load<40

2. CASE 3 Chronic Hepatitis C history Naïve…no secondary causes of liver disease F3 via non invasive methods Chooses to keep HIV meds the same and wants to try Telaprevir Very concerned about side effects/QOL during therapy Baseline HCVRNA 1.86 x 10e6

3. CASE 3 Response to PEG INF/RBV/Telaprevir Week 0 HCVRNA 1.86x10e6 Week 4 HCVRNA Detectable but <15 Week 8 HCVRNA <15 Develops rash at week 8…what information would you like?

4. CASE 3 Rash Mild, less than 50% BSA with maculopapular component on back of arms and upper back Intensely pruritic No associated constitutional symptoms No mucous membrane involvement Any questions regarding labs?

5. CASE 3 Labs CBC…no eosinophilia Liver enzymes/renal function unchanged from previous What would you do given rash?

6. CASE 3 Continues with PEG INF/RBV/Telaprevir as no concerning signs relating to rash Rash associated symptoms worsen with increasing pruritis despite local therapy with a steroid cream and Benadryl…keeping him awake causing increased agitation during the days and fatigue relating to insomnia and Benadryl effect Rash itself progresses to involve entire trunk, arms and legs to now encompass >50% body surface area (approx 65%) No constitutional symptoms, blistering, target lesions or mucous membrane involvement

7. CASE 3 End of week 10 of therapy with triple therapy What would you do?

8. CASE 3 End of week 10 of therapy with triple therapy Telaprevir discontinued and PEG INF/RBV continued Rash progressed a little further without alarming features for a further week and symptoms continued for 2 more weeks Do you think that we have increased risk of relapse given shorter course of Telaprevir?

9. CASE 3 Week 12 HCVRNA <15 Week 16 HCVRNA <15 Week 24 HCVRNA <15