1. 100% sustained virological response and fibrosis improvement in real-life use of direct acting antivirals in genotype-1b recurrent hepatitis C following liver transplantation.
- Author
-
Iacob S, Cerban R, Pietrareanu C, Ester C, Iacob R, Gheorghe C, Popescu I, and Gheorghe L
- Subjects
- 2-Naphthylamine, Adult, Aged, Anilides adverse effects, Anilides therapeutic use, Antiviral Agents adverse effects, Benzimidazoles adverse effects, Benzimidazoles therapeutic use, Carbamates adverse effects, Carbamates therapeutic use, Cyclopropanes, Drug Therapy, Combination, Female, Fluorenes adverse effects, Fluorenes therapeutic use, Genotype, Hepacivirus drug effects, Hepacivirus isolation & purification, Hepatitis C, Chronic complications, Hepatitis C, Chronic surgery, Hepatitis C, Chronic virology, Humans, Lactams, Macrocyclic, Macrocyclic Compounds adverse effects, Macrocyclic Compounds therapeutic use, Male, Middle Aged, Proline analogs & derivatives, Ribavirin adverse effects, Ribavirin therapeutic use, Ritonavir adverse effects, Ritonavir therapeutic use, Sofosbuvir, Sulfonamides adverse effects, Sulfonamides therapeutic use, Sustained Virologic Response, Uracil adverse effects, Uracil analogs & derivatives, Uracil therapeutic use, Uridine Monophosphate adverse effects, Uridine Monophosphate analogs & derivatives, Uridine Monophosphate therapeutic use, Valine, Antiviral Agents therapeutic use, Hepacivirus genetics, Hepatitis C, Chronic drug therapy, Liver Cirrhosis virology, Liver Transplantation
- Abstract
Background: Nowadays, interferon-free therapy using new direct-acting antivirals (DAA) has dramatically increased the cure rate across different HCV-infected patient populations, including groups traditionally viewed as difficult-to-treat (patients with co-infections, cirrhosis and liver transplant - LT recipients) with marked improvement in safety and tolerability., Aim: To present our experience with DAA therapy in LT recipients, as well as to compare pre- and post-treatment liver stiffness (LS) and noninvasive fibrosis scores., Methods: Our cohort consisted of 89 patients with genotype 1 (GT1) recurrent hepatitis C after LT. Seventy six patients received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin and 13 sofosbuvir/ledipasvir+/-ribavirin. Fibroscan®, FIB4 and APRI scores were performed in all patients before and 12 weeks after DAA therapy., Results: We analyzed 45 (50.5%) males and 44 (49.5%) females with a mean age of 55+/-7.7 years. Median time since LT was 20.9 months. At baseline, 53 (59.6%) of patients had severe necroinflammation at Fibromax®; advanced fibrosis (F3, F4) was encountered in 35 (39.4%) and grade 3 steatosis in 33 (37.1%) of LT recipients. End of therapy (EOT) virological response (VR) was 100%. Sustained virological response 12 weeks after therapy (SVR12) was 97.7% in the intention-to-treat analysis and 100% in per protocol analysis. There was a significant improvement in LS between antiviral therapy initiation and SVR12: 11.9+/-1.05kPa vs 8.8+/-0.6kPa (p<0.0001), as well as in APRI (2.7+/-0.3 vs 0.4+/-0.05, p<0.0001) and FIB4 (4.6+/-0.5 vs 2.5+/-0.2, p<0.0001) scores., Conclusions: In HCV positive recipients, DAA regimens are highly effective and safe. A significant decrease of LS by transient elastography and fibrosis non-invasive scores can be observed after successful therapy.
- Published
- 2018
- Full Text
- View/download PDF