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Boan P, Jamboti J, Musk M, Lavender M, Wrobel JP, Lee F, Shah A, Pereira LA, Robinson JO, Irish A. Utilising organs from hepatitis C virus PCR-positive donors in Western Australia. Intern Med J 2024; 54:678-681. [PMID: 38450913 DOI: 10.1111/imj.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/14/2024] [Indexed: 03/08/2024]
Abstract
We transplanted six solid organs from three hepatitis C virus (HCV) polymerase chain reaction (PCR)-positive donors during 2018-2023. Recipients were treated with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir for 4-12 weeks, with all six achieving sustained virological response without significant adverse events. As occurs in other jurisdictions, solid organ transplants from HCR PCR-positive donors can be safely utilised in Australia.
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Affiliation(s)
- Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| | - Jagadish Jamboti
- Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, Curtin University, Perth, Western Australia, Australia
| | - Michael Musk
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Medicine, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Felicity Lee
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Amit Shah
- Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Lynette A Pereira
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
- Department of Infectious Disease, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Owen Robinson
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
- Department of Infectious Disease, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ashley Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Whelchel K, Zuckerman AD, Koren DE, Derrick C, Bouchard J, Chastain CA. Crushing and Splitting Direct-Acting Antivirals for Hepatitis C Virus Treatment: A Case Series and Literature Review. Open Forum Infect Dis 2021; 8:ofab525. [PMID: 34805439 PMCID: PMC8601046 DOI: 10.1093/ofid/ofab525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/09/2022] Open
Abstract
Limited data exist regarding the use of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) in patients who are unable to swallow tablets. This case series describes HCV treatment in patients requiring tablet manipulation, providing evidence for safety and effectiveness of HCV DAA tablet manipulation.
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Affiliation(s)
- Kristen Whelchel
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Autumn D Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David E Koren
- Department of Pharmacy Services, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Caroline Derrick
- Department of Infectious Disease, University of South Carolina, Columbia, South Carolina, USA
| | - Jeannette Bouchard
- Department of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Cody A Chastain
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Shah RB, Garrett KL, Brotherton AL, Noska AJ. Elbasvir/grazoprevir administered for 12 weeks via percutaneous endoscopic gastrostomy tube achieves sustained virologic response: A case report and a review of the literature. Pharmacotherapy 2021; 41:634-640. [PMID: 33934388 DOI: 10.1002/phar.2531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/15/2023]
Abstract
Enteral tubes are necessary for certain patients; however, medication absorption can be affected by this route of administration potentially resulting in decreased efficacy. All first-line treatments for Hepatitis C Virus (HCV) infection are only available as tablets and may have decreased absorption if administered via an enteral tube. This report describes the first case of a pegylated interferon and ribavirin treatment-experienced patient who successfully achieved HCV cure after 12 weeks of elbasvir/grazoprevir administered via percutaneous gastrostomy tube. We further review the available pharmacokinetic and clinical literature regarding administration via enteral feeding tubes for all first-line direct-acting antivirals (DAAs). The literature suggests that crushed administration can be considered for DAAs in patients with gastric access. However, caution should be exercised in patients with extragastric enteral tubes and in those with altered gastrointestinal tract anatomy.
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Affiliation(s)
- Rajeev B Shah
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA
| | - Katy L Garrett
- Department of Pharmacy, Maine Medical Center, Portland, ME, USA
| | - Amy L Brotherton
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA
| | - Amanda J Noska
- Infectious Diseases, Essentia Health and St. Mary's Medical Center, Duluth, MN, USA
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Murayama A, Tajiri K, Kanegane C, Murakami J, Hayashi Y, Yasuda I. Successful Treatment with Crushed Sofosbuvir/Velpatasvir of a Patient with Decompensated Cirrhosis C and Thrombocytopenia. Case Rep Gastroenterol 2021; 15:729-735. [PMID: 34594173 PMCID: PMC8436629 DOI: 10.1159/000518306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023] Open
Abstract
A 36-year-old woman with decompensated liver cirrhosis type C was referred to our hospital to receive antiviral treatment for hepatitis C virus (HCV). She had been diagnosed with intractable epilepsy and cerebral palsy at birth and was managed by central venous nutrition and nasal gastric feeding. At age 34 years, she was diagnosed with thrombocytopenia, probably associated with HCV infection. She showed refractory ascites for several months and was therefore administered crushed sofosbuvir/velpatasvir tablets via a nasal gastric tube. Her HCV infection was successfully eradicated, her ascites disappeared, and thrombocytopenia improved with a marked decrease in platelet-associated IgG.
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Affiliation(s)
- Aiko Murayama
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kazuto Tajiri
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
- *Kazuto Tajiri,
| | - Chiharu Kanegane
- Department of Pediatrics, National Hospital Organization Toyama Hospital, Toyama, Japan
| | - Jun Murakami
- Division of Transfusion Medicine and Cell Therapy, Toyama University Hospital, Toyama, Japan
| | - Yuka Hayashi
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ichiro Yasuda
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
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Huffman V, Andrade DC, Sherman E, Niu J, Eckardt PA. Treatment of chronic hepatitis C virus infection with crushed ledipasvir/sofosbuvir administered through a percutaneous endoscopic gastrostomy tube in a patient with HIV coinfection. Am J Health Syst Pharm 2021; 78:36-40. [PMID: 33037429 DOI: 10.1093/ajhp/zxaa328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Ledipasvir/sofosbuvir is an oral combination therapy containing fixed doses of direct-acting antiviral agents indicated for the treatment of hepatitis C virus (HCV) infection. Currently there are limited data on the clinical efficacy of crushed ledipasvir/sofosbuvir administered via feeding tube. SUMMARY This case report discusses the successful treatment of chronic HCV genotype 1b infection with crushed ledipasvir/sofosbuvir administered through a percutaneous endoscopic gastrostomy (PEG) tube in a patient with human immunodeficiency virus (HIV) coinfection and high-grade sarcoma who had severe swallowing difficulties. The patient received crushed ledipasvir/sofosbuvir daily for a total of 12 weeks. At 12 weeks the patient had achieved a sustained virologic response. CONCLUSION Currently, ledipasvir/sofosbuvir is available only as a tablet, with limited pharmacokinetic data available to guide clinicians on use of the fixed-dose combination medication in crushed form. This case report highlights our experience treating a patient with HCV/HIV coinfection through administration of crushed ledipasvir/sofosbuvir via PEG tube, which we found to be a safe and effective therapeutic option.
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Affiliation(s)
- Vanessa Huffman
- Department of Pharmacy, Memorial Hospital West, Memorial Healthcare System, Pembroke Pines, FL
| | - Diana C Andrade
- Department of Pharmacy, Memorial Hospital West, Memorial Healthcare System, Pembroke Pines, FL
| | - Elizabeth Sherman
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL.,College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL
| | - Jianli Niu
- Office of Human Research, Memorial Healthcare System, Hollywood, FL
| | - Paula A Eckardt
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL
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Mogul A, Teixeira E, McAuliffe L, Promrat K, Zullo AR. Effectiveness of crushed sofosbuvir-velpatasvir in a patient with dysphagia. Am J Health Syst Pharm 2020; 77:417-418. [PMID: 31930300 DOI: 10.1093/ajhp/zxz326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Amanda Mogul
- Binghamton University School of Pharmacy and Pharmaceutical Sciences Binghamton, NY
| | | | | | - Kittichai Promrat
- Department of Gastroenterology Providence Veterans Affairs Medical Center Providence, RI.,Department of Medicine Alpert Medical School of Brown University Providence, RI
| | - Andrew R Zullo
- Department of Pharmacy Rhode Island Hospital Providence, RI.,Department of Health Services, Policy, and Practice Brown University School of Public Health Providence, RI
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Alimohammadi A, Conway B, Yamamoto L. Glecaprevir/pibrentasvir+sofosbuvir: an optimal retreatment strategy in the setting of HCV NS5A resistance. BMJ Case Rep 2020; 13:13/2/e233098. [PMID: 32051160 DOI: 10.1136/bcr-2019-233098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Some individuals do not achieve a cure of their hepatitis C virus (HCV) infection due to non-adherence or resistance associated substitutions. Salvage options that are optimised for resistance profiles are essential. We report a 56-year-old Caucasian man with fatigue, depression and confusion in the setting of untreated HCV genotype 3a infection. He received ruzasvir and uprifosbuvir for 12 weeks within a clinical trial. The patient relapsed 4 weeks after the end of treatment and at this time resistance testing showed multiple resistances including a NS5A Y93H mutation. Given that this mutation confers resistance to first line salvage options, sofosbuvir and glecaprevir/pibrentasvir was used for 12 weeks and the patient was cured of HCV infection 12 weeks after the end of treatment. This shows that sofosbuvir and glecaprevir/pibrentasvir is a viable, effective option for second line/salvage therapy of HCV infection in the setting of resistance to NS5A inhibitors with the Y93H mutation.
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Affiliation(s)
- Arshia Alimohammadi
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada .,Faculty of Medicine, Univertisy of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
| | - Leo Yamamoto
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada
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