Successful direct acting antiviral (DAA) treatment of HCV/HIV-coinfected patients before and after liver transplantation

Abstract

ObjectivesThe aim of this multicenter retrospective study was to investigate safety and efficacy of direct acting antiviral (DAA) treatment in the rare subgroup of patients with HCV/HIV-coinfection and advanced liver cirrhosis on the liver transplant waiting list or after liver transplantation, respectively.MethodsWhen contacting 54 German liver centers (including all 23 German liver transplant centers), 12 HCV/HIV-coinfected patients on antiretroviral combination therapy were reported having received additional DAA therapy while being on the waiting list for liver transplantation (patient characteristics: Child-Pugh A (n = 6), B (n = 5), C (n = 1); MELD range 7–21; HCC (n = 2); HCV genotype 1a (n = 8), 1b (n = 2), 4 (n = 2)). Furthermore, 2 HCV/HIV-coinfected patients were denoted having received DAA therapy after liver transplantation (characteristics: HCV genotype 1a (n = 1), 4 (n = 1)).ResultsApplied DAA regimens were SOF/DAC (n = 7), SOF/LDV/RBV (n = 3), SOF/RBV (n = 3), PTV/r/OBV/DSV (n = 1), or PTV/r/OBV/DSV/RBV (n = 1), respectively. All patients achieved SVR 12, in the end. In one patient, HCV relapse occurred after 24 weeks of SOF/DAC therapy; subsequent treatment with 12 weeks PTV/r/OBV/DSV achieved SVR 12. One patient underwent liver transplantation while on DAA treatment. Analysis of liver function revealed either stable parameters or even significant improvement during DAA therapy and in follow-up. MELD scores were found to improve in 9/13 therapies in patients on the waiting list for liver transplantation; in only 2 patients a moderate increase of MELD scores persisted at the end of follow-up.ConclusionDAA treatment was safe and highly effective in this nation-wide cohort of patients with HCV/HIV-coinfection awaiting liver transplantation or being transplanted.

miRNA expression profiles in liver grafts of HCV and HIV/HCV‐infected recipients, 6 months after liver transplantation

“…Between alcohol abuse and antiretroviral therapy‐related toxicity, hepatitis C virus (HCV) co‐infection has been so far the major underlying cause, with a reported prevalence of 70%. 1 , 2 , 3 Liver transplantation (LT) has been demonstrated to be a feasible and effective treatment for ESLD HIV‐positive patients, even in the presence of hepatocellular carcinoma (HCC) diagnosis, reaching outcomes comparable to non‐HIV patients. 1 , 2 , 3 Nonetheless, HCV/HIV co‐infected LT recipients have been characterized by a dismal outcome, mainly due to a severe HCV recurrence on the liver allograft, that is accelerated by HIV co‐infection.…”

“… 1 , 2 , 3 Liver transplantation (LT) has been demonstrated to be a feasible and effective treatment for ESLD HIV‐positive patients, even in the presence of hepatocellular carcinoma (HCC) diagnosis, reaching outcomes comparable to non‐HIV patients. 1 , 2 , 3 Nonetheless, HCV/HIV co‐infected LT recipients have been characterized by a dismal outcome, mainly due to a severe HCV recurrence on the liver allograft, that is accelerated by HIV co‐infection. 4 Nowadays, direct‐acting anti‐HCV drugs (DAAs) have been effectively controlling such risk.…”

Tacrolimus, Sirolimus and Everolimus Doses in HIV-Infected Solid-Organ Recipients, Requiring a Cobicistat-Based Antiretroviral Regimen: Report of Three Cases and Review

“…Although higher rates of acute graft rejection in PLWH undergoing SOT are still a matter of concern (in part consequent to difficulties in adapting immunosuppressors concomitantly with certain ARTs), several studies have reported patient and graft survival rates in long-term follow-up of HIV-positive kidney-transplant recipients similar to those who were HIV negative [25][26][27]. Regarding liver transplantation in HIV/HCV co-infected patients, since DAAs became available, SVRs prior to and post liver transplantation are comparable to those of HCV-mono-infected patients [28,29]. Thereby, graft and patient survival has shown improvement over time and outcomes of co-infected liver recipients are expected to match those of HCV-mono-infected patients.…”

Hepatitis C Treatment Outcomes in Persons With HIV and Decompensated Cirrhosis Using a Collaborative Multidisciplinary HIV-Centered Approach

“…Unfortunately, a liver transplant is not a viable option for most PWH in need, and many with advanced liver disease fail to link to HCV sub-specialty care. 7 Challenges to this conventional approach include the need for a sub-specialty referral and insurance approval in non-universal healthcare systems and long waiting times for a hepatology intake appointment. 8 The combination of PWH with ongoing barriers to care, internalized stigma, and low HCV knowledge also accentuate the lack of HCV linkage to care of some PWH with advanced liver disease to hepatology services.…”