A 32 year male presented with fever with altered sensorium, diagnosed to be a case of TBM, on routine blood screening he was found to have HepC positive. On retrospective evaluation he had given h/o IVD abuse. His HCV RNA was very high and genotype was 3. He improved with ATT and Steroid. Now, when to start antiviral regimen for him and what should be the best regimen?
I think to start treating the TB first as it might progress to fatal one
I suggest do the Liver function tests, then you can decide whether the patient's will be able to take the Anti-Tuberculosis. Liver disfucntion and drug induced hepatitis could worsen the situation.
Decide to start the Anti-Tb
Hepatologists don't recommend treating the hep c while treating TB because of the risk of liver toxicity from the TB meds. Also, steroids facilitate HCV cell entry.
Best regimen for a genotype 3, Sofosbuvir/Daclatasvir.
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