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Peginterferon and Ribavirin for Treatment of Recurrent Hepatitis C Disease in HCV-HIV Coinfected Liver Transplant Recipients


Journal Article

Terrault, N.; Reddy, K.R.; Poordad, F.; Curry, M.; Schiano, T.; Johl, J.; Shaikh, O.; Dove, L.; Shetty, K.; Millis, M.; Schiff, E.; Regenstein, F.; Barnes, D.; Barin, B.; Peters, M.; Roland, M.; Stock, P.; Investigators, T.H.I.V.T.R.

Am J Transplant




antiviral therapy; histologic response; Sustained virologic response

Achievement of a sustained virologic response (SVR) with antiviral therapy significantly improves graft survival in hepatitis C virus (HCV) monoinfected liver transplant (LT) patients. Risks and benefits of HCV therapy in HCV-human immunodeficiency virus (HIV) coinfected LT recipients are not well established. Among 89 HCV-HIV LT recipients in the HIVTR cohort, 39 (23% Black, 79% genotype 1, 83% fibrosis stage ≤ 1) were treated with peginterferon-a2a or a2b plus ribavirin for a median 363 days (14-1373). On intent-to-treat basis, 22% (95% CI: 10-39) and 14% (95% CI: 5-30) achieved an end-of-treatment response (EOTR) and SVR, respectively. By per-protocol analysis (completed 48 weeks of therapy ± dose reductions), 42% and 26% had EOTR and SVR, respectively. Severe adverse events occurred in 85%, with 26% hospitalized with infections and 13% developing acute rejection. Early discontinuations and dose reductions occurred in 38% and 82%, respectively, despite use of growth factors in 85%. Eighteen of 39 treated patients (46%) subsequently died/had graft loss, with 10 (26%) attributed to recurrent HCV. In conclusion, SVR rates are low and tolerability is poor in HCV-HIV coinfected transplant recipients treated with peginterferon and ribavirin. These results highlight the critical need for better tolerated and more efficacious HCV therapies for HCV-HIV coinfected transplant recipients.

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