Antiviral therapy for hepatitis C virus recurrence after liver transplantation in HIV-infected patients: outcome in the Bonn cohort.

Antiviral therapy for hepatitis C virus recurrence after liver transplantation in HIV-infected patients: outcome in the Bonn cohort

Wojcik K, Vogel M, Voigt E et al.

AIDS, 2007, 21, 1363-1365

With the accelerated course of hepatitis C in HIV-coinfected individuals the need for liver transplantation in this particular patient population clearly has increased over the last years. Unfortunately, the long-term outcome of liver transplantation in HIV/HCV co-infected individuals is threatened by recurrence of hepatitis C shortly after organ transplantation. The course of recurrent hepatitis C is usually extremely aggressive and may limit overall post-transplant survival. It still remains controversial when best to treat recurrent hepatitis C, how long to treat recurrent hepatitis C and what will be considered the best treatment algorithm in this difficult-to-treat patient population. In the current paper by Wojcik et al. a series of four transplanted HIV/HCV-positive patients are presented who were all treated for recurrent hepatitis C after organ transplantation with pegylated interferon and ribavirin. All four patients were haemophiliac men who had been transplanted for chronic hepatitis C. Two of them had been previous non-responders to interferon/ribavirin therapy before transplantation while the other two were treatment-naive. Two patients had genotype 1a and one patient each had genotype 2a/c and 3a. Pre-treatment liver biopsies revealed Metavir scores A1/F0 in patient 1 at week 2, A1/F0 in patient 2 at week 3, A1/F0 in patient 3 at week 6, and A0/F1 in patient 4 at week 4 after OLT. Anti-HCV treatment was started 9 weeks (range 6-15 weeks) after OLT. Patients with HCV-genotype 1 were treated for 10 and 12 months, patients with genotype 3, for 6 months. At week 12, HCV-RNA had become undetectable in two patients and was reduced by at least 1.8 log in patient 1, patient 3 only achieved a 0.9 log reduction at week 12 but became HCV-RNA negative at week 24. His therapy was extended to 12 months. At the end of treatment and at follow-up all patients were HCV-RNA negative. Clearly these results are in contrast to the observations from larger cohorts from Spain describing sustained virological response rates of around 25% after treating the recurrence of HCV. The low number of patients from this report limits the overall conclusions of this paper; however, it does suggest that tailoring treatment duration to each patient according to the decline in HCV-RNA and management of side-effects are key factors for improving efficacy. Moreover, early therapy after HCV recurrence may be helpful to achieve better SVR rates.

Review by Jurgen Rockstroh

Dept. of Medicine, University of Bonn, Germany