1
|
Zanaga LP, Vigani AG, Angerami RN, Giorgetti A, Escanhoela CAF, Ataíde EC, Boin IFSF, Stucchi RSB. Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation. ACTA ACUST UNITED AC 2017; 50:e5540. [PMID: 28076451 PMCID: PMC5264534 DOI: 10.1590/1414-431x20165540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and
can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment
can be used to prevent these detrimental outcomes. The aim of this study was to
describe rates of hepatitis C recurrence and sustained virological response (SVR) to
interferon-based treatment after OLT and its relationship to survival and progression
of liver disease through retrospective analysis of medical records of 127 patients
who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic
hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed
with recurrent disease, 42 started interferon-based therapy and 37 completed
treatment. Demographic, treatment- and outcome-related variables were compared
between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with
interferon-based therapies. SVR was associated with longer follow-up after treatment
(median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median
105 vs 72 months, P=0.074), and lower rates of disease progression
(15 vs 64.7%, P=0.0028) and death (5 vs 35.3%,
P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a
significant difference between treated and untreated patients regarding the
occurrence of death (P<0.001) and months of survival (P<0.001). Even with
suboptimal interferon-based therapies (compared to the new direct-acting antivirals)
there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and
reduced risks of clinical decompensation, loss of the liver graft and death.
Collapse
Affiliation(s)
- L P Zanaga
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A G Vigani
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R N Angerami
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - A Giorgetti
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - C A F Escanhoela
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - E C Ataíde
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - I F S F Boin
- Unidade de Transplante de Fígado, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - R S B Stucchi
- Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| |
Collapse
|
2
|
Saleem A, Akhtar MF, Mushtaq MF, Saleem M, Muhammad ST, Akhtar B, Sharif A, Peerzada S. Current trends in the treatment of hepatitis C: interventions to avoid adverse effects and increase effectiveness of anti-HCV drugs. EXCLI JOURNAL 2016; 15:578-588. [PMID: 28096788 PMCID: PMC5225681 DOI: 10.17179/excli2016-582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/26/2016] [Indexed: 12/14/2022]
Abstract
Viral hepatitis, an inflammatory liver disease, is caused by various genotypes of hepatitis C viruses (HCV). Hepatitis C slowly sprouts into fibrosis, which progresses to cirrhosis. Over a prolonged period of time compensated cirrhosis can advance to decompensated cirrhosis culminating in hepatic failure and death. Conventional treatment of HCV involves the administration of interferons. However, association of interferon with the adverse drug reactions led to the development of novel anti-HCV drugs given as monotherapy or in combination with the other drugs. Advances in drug delivery systems (DDS) improved the pharmacokinetic profile and stability of drugs, ameliorated tissue damages on extravasation and increased the targeting of affected sites. Liposomes and lipid based vehicles have been employed with polyethylene glycol (PEG) so as to stabilize the formulations as PEG drug complex. Sofosbuvir, a novel anti-HCV drug, is administered as monotherapy or in combination with daclatasvir, ledipasivir, protease inhibitors, ribavirin and interferon for the treatment of HCV genotypes 1, 2 and 3. These drug combinations are highly effective in eradicating the interferon resistance, recurrent HCV infection in liver transplant, concurrent HIV infection and preventing interferon related adverse effects. Further investigations to improve drug targeting and identification of new drug targets are highly warranted due to the rapid emergence of drug resistance in HCV.
Collapse
Affiliation(s)
- Ammara Saleem
- Faculty of Pharmaceutical Sciences, GC University, Faisalabad, Pakistan
| | | | | | - Muhammad Saleem
- Faculty of Pharmaceutical Sciences, GC University, Faisalabad, Pakistan
| | | | - Bushra Akhtar
- Institute of Pharmacy, Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
| | - Ali Sharif
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Sohaib Peerzada
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| |
Collapse
|
3
|
Boone JM, Cui W. Spectrum of bone marrow morphologic findings in hepatitis C patients with and without prior liver transplantation. Int J Lab Hematol 2016; 38:694-702. [PMID: 27572295 DOI: 10.1111/ijlh.12559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cytopenia is a common hematologic finding in patients with HCV infection. Only a few studies have addressed bone marrow (BM) morphologic findings in these patients. No systemic study has been performed in these patients with liver transplantation (LT). METHODS We retrospectively examined BMs in 49 hepatitis C patients with and without prior LT (n = 19 and n = 30). RESULTS Among the patients with an available complete blood count (n = 46), the majority of them presented with cytopenia involving one or multiple cell lineages including unicytopenia (13%, n = 6), bicytopenia (31%, n = 14), and pancytopenia (43%, n = 20). Examination of the BM revealed a wide spectrum of morphologic findings ranging from benign reactive processes to overt malignant processes which included myeloid, lymphoid, and plasma cell neoplasms. The severity of cytopenia was not correlated with cirrhosis or antiviral therapy. However, the severity of cytopenia was partly correlated with splenomegaly or LT (P < 0.05). CONCLUSIONS Cytopenia is a common finding in hepatitis C patients. Hypersplenism or LT has an adverse impact on some blood cell counts. Lastly, hepatitis C patients present with a wide spectrum of BM findings including malignant neoplasms, which indicates a diagnostic value of BM examination in these patients.
Collapse
Affiliation(s)
- J M Boone
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - W Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
4
|
Leask JD, Dillon JF. Review article: treatment as prevention - targeting people who inject drugs as a pathway towards hepatitis C eradication. Aliment Pharmacol Ther 2016; 44:145-56. [PMID: 27199103 DOI: 10.1111/apt.13673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/29/2016] [Accepted: 05/02/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. HCV predominates in people who inject drugs; a group in whom anti-viral therapy has previously been withheld on the basis of chaotic lifestyles and associated risks of reinfection. New research has emerged which suggests that by specifically targeting HCV-infected people who inject drugs for treatment, the pool of HCV would deplete, thus reducing overall transmission and eventually leading to HCV eradication. AIM To outline the requirements for HCV eradication and review the evidence that this is achievable. METHODS Expert review of the literature. RESULTS The achievement of HCV eradication using 'treatment as prevention' is supported by numerous epidemiological modelling studies employing a variety of models in several contexts including people who inject drugs, men who have sex with men and prisoners. More recent studies also incorporate the newer, more efficacious direct-acting anti-viral drugs. These drugs have been shown to be safe and effective in people who inject drugs in clinical trials. There is no empirical evidence of the impact of treatment as prevention strategies on population prevalence. CONCLUSIONS This review highlights the efforts to control HCV and evaluates the possibilities of achieving eradication of HCV. Currently, the technologies required to achieve HCV eradication exist, but the infrastructure to deliver them is not generally available or of insufficient scale outside of specific areas. Such areas are yet to demonstrate that elimination is possible, but results of studies in these areas are awaited. Such a demonstration would be proof of principle for eradication. Although we are aspiring towards HCV eradication, elimination is the more realistic prospect.
Collapse
Affiliation(s)
- J D Leask
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| |
Collapse
|
5
|
Ciesek S, Proske V, Otto B, Pischke S, Costa R, Lüthgehetmann M, Polywka S, Klempnauer J, Nashan B, Manns MP, von Hahn T, Lohse AW, Wedemeyer H, Mix H, Sterneck M. Efficacy and safety of sofosbuvir/ledipasvir for the treatment of patients with hepatitis C virus re-infection after liver transplantation. Transpl Infect Dis 2016; 18:326-32. [PMID: 26988272 DOI: 10.1111/tid.12524] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/14/2016] [Accepted: 02/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with a particularly poor outcome after liver transplantation. In December 2014, sofosbuvir/ledipasvir (SOF/LDV) fixed-dose combination (FDC) was approved for HCV genotype 1 and 4 in Europe. In orthotopic liver transplantation (OLT) recipients, the interferon-free treatment of HCV re-infection with novel direct-acting antivirals has been demonstrated to be safe and effective in clinical trials, but real-world data are missing. The aim of this study was to investigate the safety and efficacy of SOF/LDV FDC in OLT recipients in the real-life setting. METHODS All consecutive OLT patients started on SOF/LDV FDC for 12 or 24 weeks at the University Medical Center Hamburg-Eppendorf and Medical School Hannover between October 2014 and August 2015 were retrospectively analyzed (n = 30). The primary efficacy endpoint was sustained virological response (SVR), i.e., absence of viremia 12 weeks after end of treatment (SVR 12). Liver function tests, creatinine, blood count, and HCV RNA (by polymerase chain reaction assay) were determined at each visit. RESULTS SVR was achieved in 29/30 patients (96.67%) treated with SOF/LDV ± ribavirin (RBV) for 12 (n = 4) or 24 weeks (n = 25). Twenty-five patients (86.2%) received RBV. However, in 15 of the 25 patients, RBV administration had to be discontinued because of severe anemia (57.7%). One RBV-treated patient died of a myocardial infarction during antiviral therapy; this event was most likely not directly related to SOF/LDV. Aside from RBV-associated anemia, no severe side effects of the antiviral regimen were observed. CONCLUSION Antiviral treatment with SOF/LDV is highly effective, safe, and well tolerated in OLT recipients. The addition of RBV often results in severe anemia, requiring dose reduction or discontinuation.
Collapse
Affiliation(s)
- S Ciesek
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - V Proske
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Otto
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - S Pischke
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - R Costa
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - M Lüthgehetmann
- Institute for Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Institute for Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Klempnauer
- Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany.,General-, Visceral- and Transplant Surgery, Medical School Hannover, Hannover, Germany
| | - B Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - T von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - A W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany.,Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Mix
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - M Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| |
Collapse
|