title: An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients.
abstract: BACKGROUND
  Ribavirin is efficient at treating chronic hepatitis E virus infection in solid-organ transplant patients. However, the early kinetics of viral replication under therapy and the impact of immunosuppressant regimens on viral replication are unknown: thus, determining the aim of our study.
  
  
  METHODS
  Thirty-five patients with a solid-organ transplant and chronic hepatitis E virus infection were given ribavirin for 3 months. The hepatitis E virus (HEV) RNA concentrations were determined before treatment, at days 7, 15, and 21 and at months 1, 2, and 3 during therapy and after ribavirin cessation.
  
  
  RESULTS
  A sustained virological response (SVR) occurred in 63%. Decreased viral concentration within the first week post-ribavirin therapy was an independent predictive factor for SVR, and a decreased HEV concentration of 0.5 log copies/mL or greater had an 88% positive predictive value. No correlation between ribavirin trough level on day 7 or at month 2 with a virological response or an SVR was observed. Before therapy, HEV RNA concentration was significantly greater in patients receiving mechanistic target of rapamycin inhibitor-based immunosuppression compared to patients given calcineurin inhibitors. The use of mycophenolic acid did not impact on the response to ribavirin.
  
  
  CONCLUSIONS
  An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.
authors.affiliation: 1 Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France. 2 INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. 3 Université Paul Sabatier, Toulouse, France. 4 Laboratory of Virology, CHU Purpan, Toulouse, France. 5 Department of Thoracic Surgery and Lung Transplantation, CHU Rangueil-Larrey, Toulouse, France. 6 Pediatric Hepatology, Hôpital des enfants, Toulouse, France. 7 Laboratory of Toxicology, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Sebastien
authors.initials: S
authors.lastname: Lhomme
authors.forename: Florence
authors.initials: F
authors.lastname: Abravanel
authors.forename: Olivier
authors.initials: O
authors.lastname: Cointault
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cardeau-Desangles
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Dörr
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.forename: Marie Béatrice
authors.initials: MB
authors.lastname: Nogier
authors.forename: Joelle
authors.initials: J
authors.lastname: Guitard
authors.forename: David
authors.initials: D
authors.lastname: Ribes
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Goin
authors.forename: Pierre
authors.initials: P
authors.lastname: Broué
authors.forename: David
authors.initials: D
authors.lastname: Metsu
authors.forename: Karine
authors.initials: K
authors.lastname: Sauné
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D002648:Child; D005260:Female; D016751:Hepatitis E / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000032:analysis; D012254:Ribavirin / Q000627:therapeutic use*; D014779:Virus Replication / Q000187:drug effects; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D012254:Ribavirin