Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study
Manzardo C (1), Londoño MC (1,2), Castells L (2,3), Testillano M (4), Montero J L (2,5), Peñafiel J (1), Subirana M (1), Moreno A (6), Aguilera V (7), González-Diéguez ML (8), Calvo-Pulido J (9), Xiol X (10), Salcedo M (11), Cuervas-Mons V (12), Sousa JM (13), Suarez F (14), Serrano T (15,16), Herrero JI (2,17), Jiménez M (18), Fernandez JR (4), Giménez C (9), Del Campo S (6), Esteban-Mur JI (2,3), Crespo G (1,2), Moreno A (1), de la Rosa G (19), Rimola A (1,2), Miro JM (1); FIPSE LT-HIV investigators.
(1) Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona.
(3) Hospital Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona.
(4) Servicio de Digestivo. Hospital Universitario Cruces, Barakaldo.
(5) Hospital Universitario Reina Sofía-IMIBIC Córdoba.
(6) Hospital Universitario Ramón y Cajal-IRYCIS, Madrid.
(7) Hospital Universitari La Fe, Valencia.
(8) Hospital Universitario Central de Asturias, Oviedo.
(9) Hospital Universitario Doce de Octubre, Madrid.
(10) Hospital de Bellvitge-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona.
(11) Hospital General Universitario Gregorio Marañón, Madrid.
(12) Hospital Universitario Puerta de Hierro, Madrid.
(13) Hospital Universitario Virgen del Rocío, Sevilla.
(14) Complejo Hospitalario Universitario, A Coruña.
(15) Hospital Universitario Lozano Blesa, ISS Aragón, Zaragoza.
(16) Hospital Universitario Lozano Blesa, Zaragoza.
(17) Clínica Universidad de Navarra, IdiSNA, Pamplona.
(18) Hospital Universitario Carlos Haya, Málaga.
(19) Organización Nacional de Trasplantes, Madrid.
Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection.
However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAAs therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment.
Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/μL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF+LDV±RBV (34%), SOF+SMV±RBV (31%), SOF+DCV±RBV (27%), SMV+DCV±RBV (5%), and 3D (3%), with no differences between the groups.
Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; p=0.239). Albeit not significant, a trend towards lower SVR rates among patients with advanced fibrosis (p=0.093) and genotype 4 (p=0.088) was observed.
CITATION Am J Transplant. 2018 Jul 2. doi: 10.1111/ajt.14996