title: IFN-free therapy for HIV/HCV-coinfected patients within the liver transplant setting.
abstract: IFN-based therapy against hepatitis C recurrence after liver transplantation (LT) has poor effectiveness and tolerability. In HIV/HCV-coinfected liver transplant recipients, the results are even poorer. Here, we report our experience using direct antiviral agents (DAAs) in 11 consecutive coinfected patients within the LT setting.
  
  
  
  Four patients with compensated cirrhosis and hepatocellular carcinoma were treated while awaiting LT and seven patients received antiviral therapy due to severe hepatitis C recurrence after LT [fibrosing cholestatic hepatitis (n = 1), fibrosis stage ≥F3 (n = 2) and decompensated cirrhosis (n = 4)]. Patients were treated with different sofosbuvir-based regimens with or without ribavirin for 12 or 24 weeks.
  
  
  
  Sustained virological response (SVR) was achieved in all patients. Two of the four patients treated while awaiting LT reached the time of transplant with undetectable HCV-RNA that remained undetectable 12 weeks after LT, one patient had detectable HCV-RNA at the time of transplant but achieved SVR after completing 12 weeks of therapy after LT and the last patient is still on the waiting list. Seven patients with severe post-LT hepatitis C recurrence were treated within 11-120 months after LT. In these patients, viral eradication was associated with an improvement in liver function and clinical decompensation. Tolerance to antiviral therapy was good and only four patients reported mild adverse events.
  
  
  
  IFN-free regimens are effective and well tolerated in HIV/HCV-coinfected patients within the LT setting, but more data are needed to confirm our promising results and to establish the best treatment option in this population.
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain mlondono@clinic.ub.es.
authors.forename: Maria-Carlota
authors.initials: MC
authors.lastname: Londoño
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Christian
authors.initials: C
authors.lastname: Manzardo
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Microbiology Service (CDB), Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Costa
authors.affiliation: Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Forner
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ambrosioni
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Agüero
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Laguno
authors.affiliation: Addictive Behavior Unit, Hospital Clínic Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Lligoña
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Jose-Maria
authors.initials: JM
authors.lastname: Miró
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000009:adverse effects / Q000627:therapeutic use; D000072230:Sustained Virologic Response; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069474:Sofosbuvir