Abstract
Achievement of a sustained virologic response (SVR) with antiviral therapy significantly improves graft survival in hepatitis C virus (HCV) monoinfected liver transplant (LT) patients. Risks and benefits of HCV therapy in HCV–human immunodeficiency virus (HIV) coinfected LT recipients are not well established. Among 89 HCV–HIV LT recipients in the HIVTR cohort, 39 (23% Black, 79% genotype 1, 83% fibrosis stage ≤ 1) were treated with peginterferon‐a2a or a2b plus ribavirin for a median 363 days (14–1373). On intent‐to‐treat basis, 22% (95% CI: 10–39) and 14% (95% CI: 5–30) achieved an end‐of‐treatment response (EOTR) and SVR, respectively. By per‐protocol analysis (completed 48 weeks of therapy ± dose reductions), 42% and 26% had EOTR and SVR, respectively. Severe adverse events occurred in 85%, with 26% hospitalized with infections and 13% developing acute rejection. Early discontinuations and dose reductions occurred in 38% and 82%, respectively, despite use of growth factors in 85%. Eighteen of 39 treated patients (46%) subsequently died/had graft loss, with 10 (26%) attributed to recurrent HCV. In conclusion, SVR rates are low and tolerability is poor in HCV–HIV coinfected transplant recipients treated with peginterferon and ribavirin. These results highlight the critical need for better tolerated and more efficacious HCV therapies for HCV–HIV coinfected transplant recipients.
The authors show that treatment of HCV‐HIV coinfected transplant recipients with peginterferon and ribavirin yielded sustained virology responses in only 14% and with high rates of dose reductions (85%), early discontinuation (38%), and severe adverse events (85%).
