Peginterferon and ribavirin for treatment of recurrent hepatitis C disease in HCV-HIV coinfected liver transplant recipients.

Publication Type
Journal Article
Year of Publication
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; HIVTR Investigators
Am J Transplant
Date Published
2014 May
Adolescent; Adult; Aged; Antiviral Agents; Child; DNA, Viral; Drug Therapy, Combination; Female; Follow-Up Studies; Graft Rejection; Hepacivirus; Hepatitis C, Chronic; HIV; HIV Infections; Humans; Interferon-alpha; Liver Diseases; liver transplantation; Male; Middle Aged; Polyethylene Glycols; Polymerase Chain Reaction; prognosis; Prospective Studies; Recombinant Proteins; Ribavirin; Survival Rate; Transplant Recipients; Treatment Outcome; Young Adult

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.