Worse Response to PegIFN/RBV for HCV After Transplant in HIV/HCV+ vs HCV+
People coinfected with HIV and HCV had a lower
chance of responding to pegylated interferon plus ribavirin (PegIFN/RBV)
for recurrent HCV after liver transplantation than did people infected
only with HCV. Five-year survival was high in both groups among the
minority who achieved sustained virologic response (SVR) to PegIFN/RBV.
Recurrent HCV infection after liver transplantation poses a high risk of
liver graft loss and death in HIV/HCV-coinfected people. But aside from
data from a few small case series, few findings have emerged on
response to PegIFN/RBV among coinfected people with recurrent HCV after
transplantation. In part to address that lack, Spanish investigators are
conducting the prospective multicenter observational FIPSE study
comparing coinfected and monoinfected posttransplant patients.
Patients with recurrent HCV benefit from triple therapy after liver transplant
Triple therapy was effective in a cohort of liver transplant
recipients with recurrent hepatitis C, although adverse events were
common in a recent study.
In a multicenter cohort study in France, researchers evaluated 37 patients with recurrent hepatitis C genotype 1 who underwent liver transplantation
(LT) and received triple therapy with either boceprevir (n=18) or
telaprevir (n=19) in addition to pegylated interferon and ribavirin, for
a median of 41 weeks. The cohort included 18 patients who were
treatment naive and five who had relapsed and 14 who had been
nonresponsive during prior dual therapy after transplantation. Patients
received calcineurin inhibitor (CNI) therapy with cyclosporine (n=22) or
At 12 weeks of treatment, 89% of boceprevir and 58% of telaprevir recipients experienced complete virological response (P=.06), while end-of-treatment response was observed in 72% of evaluable boceprevir recipients and 40% of telaprevir recipients.
Sustained virological response 12 weeks after treatment completion
occurred in 71% of evaluable boceprevir patients and 20% of evaluable
telaprevir recipients (P=.24).
Liver transplant recipients with HCV and lymphopenia had poorer
survival and a greater risk for recurrence than patients with higher
absolute lymphocyte counts in a recent study.
Researchers evaluated the absolute lymphocyte counts (ALCs) of 289 patients with HCV who underwent liver transplantation
(LT) between 2005 and 2011, including ALC before transplantation and 2
weeks and 1 month post-LT, with follow-up across a median of 2.8 years.
Patients were stratified according to ALC: below 500/mcL, 500 to
1,000/mcL and more than 1,000/mcL.