title: Peginterferon and ribavirin for treatment of recurrent hepatitis C disease in HCV-HIV coinfected liver transplant recipients.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA.
authors.forename: N
authors.initials: N
authors.lastname: Terrault
authors.forename: K R
authors.initials: KR
authors.lastname: Reddy
authors.forename: F
authors.initials: F
authors.lastname: Poordad
authors.forename: M
authors.initials: M
authors.lastname: Curry
authors.forename: T
authors.initials: T
authors.lastname: Schiano
authors.forename: J
authors.initials: J
authors.lastname: Johl
authors.forename: O
authors.initials: O
authors.lastname: Shaikh
authors.forename: L
authors.initials: L
authors.lastname: Dove
authors.forename: K
authors.initials: K
authors.lastname: Shetty
authors.forename: M
authors.initials: M
authors.lastname: Millis
authors.forename: E
authors.initials: E
authors.lastname: Schiff
authors.forename: F
authors.initials: F
authors.lastname: Regenstein
authors.forename: D
authors.initials: D
authors.lastname: Barnes
authors.forename: B
authors.initials: B
authors.lastname: Barin
authors.forename: M
authors.initials: M
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Roland
authors.forename: P
authors.initials: P
authors.lastname: Stock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D004279:DNA, Viral / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D006678:HIV / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D015996:Survival Rate; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: Sustained virologic response; antiviral therapy; histologic response