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Hepatitis C Genotype 4 Virus Nonstructural 3 and Nonstructural 5A Resistance-associated Substitutions in a 16-year-old Adolescent Failing Ombitasvir/Paritaprevir/Ritonavir Plus Ribavirin

Serranti, Daniele, MD*; Indolfi, Giuseppe, MD*; Caudai, Cinzia, MD; Bartolini, Elisa, MD*; Trapani, Sandra, MD*; Zazzi, Maurizio; Resti, Massimo, MD*

The Pediatric Infectious Disease Journal: April 2019 - Volume 38 - Issue 4 - p e72–e74
doi: 10.1097/INF.0000000000002137
Instructive Cases

Preexistence and appearance of resistance-associated substitutions limit the efficacy of direct-acting antivirals in treatment of hepatitis C. This is the first case report of an adolescent with chronic hepatitis C virus genotype 4 infection and cirrhosis who failed treatment with ombitasvir/paritaprevir/ritonavir and ribavirin. Resistance analysis showed baseline resistance-associated substitutions M28V and Y93C and emergent D168H.

From the *Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence, Florence, Italy

Microbiology and Virology Unit, Siena University Hospital

Department of Medical Biotechnologies, University of Siena, Siena, Italy.

Accepted for publication May 19, 2018.

D.S. and G.I. are investigators in a study sponsored by Gilead Sciences (NCT02175758). The remaining authors have no funding or conflicts of interest to disclose.

Address for correspondence: Giuseppe Indolfi, MD, Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence, Viale Gaetano Pieraccini 24, Firenze, 50139, Italy. E-mail:

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