Antiviral therapy for hepatitis C virus recurrence after liver transplantation in HIV-infected patients: outcome in the Bonn cohort

Abstract

Recurrent hepatitis C is a major cause of mortality in HIV/hepatitis C virus (HCV)-co-infected patients after orthotopic liver transplantation. We report sustained viral clearance in all four transplanted HIV/HCV-positive patients treated with pegylated interferon/ribavirin. Early therapy after HCV recurrence, tailoring treatment duration to the individual decline in HCV-RNA and the management of side effects are key factors for improved efficacy. At experienced centres interferon treatment is a valuable option for recurrent hepatitis C in HIV-positive patients.

Liver transplantation in human immunodeficiency virus-positive patients

“…Some groups begin treatment within 90 days of transplantation, whereas others have advocated its initiation at the first sign of histological disease (median time ¼ 12 weeks). 74,75 The reported sustained virological response rates range from 11% to 27%, and a treatment duration of 48 weeks is usually recommended. 66,74,75 Certain antiretroviral drugs and particularly abacavir-based regimens are also associated with an increased risk of failure to achieve a sustained virological response due to the impairment of ribavirin phosphorylation; therefore, they should be avoided.…”

“…74,75 The reported sustained virological response rates range from 11% to 27%, and a treatment duration of 48 weeks is usually recommended. 66,74,75 Certain antiretroviral drugs and particularly abacavir-based regimens are also associated with an increased risk of failure to achieve a sustained virological response due to the impairment of ribavirin phosphorylation; therefore, they should be avoided. 76 The concurrent use of ribavirin and didanosine should be avoided because of the increased risk of mitochondrial toxicity.…”

Liver transplantation in HCV/HIV positive patients

“…The mitochondrial toxicity of HAART, however, increases when used in conjunction with ribavirin [86,87] . The rates of a sustained virological response (SVR) are low in co-infected patients, apart from one recent study that showed 100% SVR [88] . SVR occurs in only 11% to 27% of treated patients [35,42,88,89] (Table 2).…”

“…The rates of a sustained virological response (SVR) are low in co-infected patients, apart from one recent study that showed 100% SVR [88] . SVR occurs in only 11% to 27% of treated patients [35,42,88,89] (Table 2). Biochemical responses are obtained in more than half of patients but histological stabilization or improvement is rare in virological nonresponders.…”

The Role of Liver Transplantation in HIV Positive Patients

“…Treatment for recurrent HCV post-LT in our institution is instigated when histological disease is demonstrable (F≥2) although some groups have commenced treatment within 90 days of LT (70,71). The concurrent use of didanosine and ribavirin is not recommended due to increased risk of mitochondrial toxicity (72).…”