Chronic Hepatitis C Treatment Failure With Crushed Sofosbuvir/Velpatasvir in a Patient With Total Parenteral Nutrition-dependent Short Bowel Syndrome.

This article focuses on the treatment challenges of chronic hepatitis C virus (HCV) infection in a 61-year-old patient with short bowel syndrome dependent on total parenteral nutrition (TPN). The patient was treated with crushed, orally administered sofosbuvir/velpatasvir (SOF/VEL) for 12 weeks but failed to achieve sustained virologic response (SVR12), suggesting possible impaired drug absorption due to altered gastrointestinal anatomy. The report highlights the complexity of drug interactions and absorption issues in patients with multimorbidity and notes that while other direct-acting antivirals (DAAs) like glecaprevir/pibrentasvir (GLE/PIB) have shown success in similar cases, they were contraindicated here due to interactions with the patient’s fentanyl therapy. The authors recommend further pharmacokinetic studies and consideration of alternative dosing routes for DAAs in patients with short bowel syndrome and TPN dependence.