Impact of sustained viral response for hepatitis C virus on the outcomes of liver transplantation in hemophilic patients with human immunodeficiency virus/hepatitis C virus co‐infection: A nationwide survey in Japan

Abstract

Aim: Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection from blood products for hemophilia has been a social problem in Japan, and liver transplantation (LT) for these patients has been a challenging procedure. However, with the advent of the direct-acting antiviral agent for HCV and change in the policy for prioritization of deceased donor LT, the results of LT for patients co-infected with HCV/HIV may have improved.Methods: This study was conducted to provide updated results of our nationwide survey of LT for patients co-infected with HCV/HIV, from January 1997 to December 2019. We collected data on 17 patients with HIV/HCV co-infection who underwent either deceased donor LT (n = 5) or living donor LT (n = 12).

Residual burden of liver disease after HCV clearance in hemophilia: a word of caution in the era of gene therapy

“… 3 Unfortunately, although a sustained virological response (SVR) abolishes the risk of liver complications in the early disease stages, advanced fibrosis/cirrhosis at the time of SVR may curb the reduction of such complications as portal hypertension, hepatocellular carcinoma (HCC), and the need for transplantation. 4 , 5 , 6 , 7 , 8 , 9 , 10 Furthermore, highly prevalent comorbidities and lifestyles, such as obesity, diabetes, and alcohol intake, are per se crucial risk factors for the progression of liver damage in PWH. 11 , 12 , 13 …”

“… 14 Firstly, patients who at the time of SVR have compensated liver disease in the form of advanced fibrosis/cirrhosis (the so called compensated advanced chronic liver disease [cACLD]) must continue the 6-monthly screening for HCC, which remains the most frequent complication despite HCV clearance. 8 , 10 , 15 Secondly, patients who had already experienced complications because of portal hypertension (eg, varices, ascites, variceal hemorrhage, and hepatic encephalopathy) have only a partial reduction of portal pressure, which, despite HCV clearance, exposes them to a risk of decompensation/further decompensation. 4 , 6 Lastly, a first event of decompensation should be monitored and prevented in patients with cACLD achieving SVR when another risk factor of liver damage is present (alcohol intake and metabolic comorbidities).…”