Role of Direct Antiviral Agents in Treatment of Chronic Hepatitis C Infection in Renal Transplant Recipients

B-cell Clonality in HCV-Induced Patients Treated with Oral Direct-Acting Antiviral Agents

BACKGROUND

Hepatitis C virus (HCV) is a worldwide' health problem as Egypt has a very high prevalence (14.7%) that may affect the B-Lymphocytes, and in some cases leading to an expansion of monoclonal B-cell detected by immunoglobulin heavy chain (IgH) gene rearrangement. Therefore, we aimed to assess the occurrence of IgH gene rearrangement in Egyptian chronic HCV patients and studying the effect of oral direct-acting antiviral (DAAs) therapy on regression of the clonality markers.

METHODS

78 Egyptian patients with chronic HCV infection were included in this study and polymerase chain reaction (PCR) analysis was used to detect IgH rearrangement based on standardized PCR protocols of the BIOMED-2 international guidelines study.

RESULTS

Clonal IgH showed a significant increase of HCV-RNA expression and correlated with increased alanine transaminase (ALT) in all patients, while a significant increase of kappa and lambda free light chain observed only in clonal IgH with lymphoproliferative disorders (LPD) patients. A total of 37.17% (29/78) IgH clonality was detected in all patients (7.69% with LPD and 29.48% without LPD). 37% of these IgH clonality disappeared with HCV eradication after DAAs regimen.

CONCLUSIONS

we concluded that different DAAs regimen with or without RBV is safe and effective for the treatment of Egyptian patients, but its effect is partially and not completely in the eradication of IgH clonality. Also, using IgH rearrangement in patients with chronic HCV is helpful as indicator in patients at high risk for prediction of LPD.

The effect of anemia on the efficacy and safety of treating chronic hepatitis C infection with direct-acting antivirals in patients with chronic kidney disease

BACKGROUND/AIM

Chronic hepatitis-C infection is a great health burden in Egypt. The effect of anemia on the efficacy and safety of direct-acting anti-viral (DAA) therapies for those with chronic-kidney disease (CKD) has not been evaluated.

PATIENTS/METHODS

This single-center retrospective study included 235 renal patients: i.e., 70-CKD patients not on hemodialysis (42 with anemia, 28 without); 40 hemodialysis patients (16 anemic; 24 non-anemic), and 125 kidney-transplant (KTx) recipients (40 anemic; 85 non-anemic). Anemia was defined by a hemoglobin level < 10.5 g/dL. Hemodialysis patients received ritonavir-boosted paritaprevir/ombitasvir. KTx patients received sofosbuvir/daclatasvir. CKD patients with eGFR > 30 mL/min/1.73 m² received sofosbuvir/daclatasvir. Those with eGFR < 30 mL/min/1.73 m² received ritonavir-boosted paritaprevir/ombitasvir; 64 non-anemic patients also received ribavirin therapy.

RESULTS

Mean age of CKDs was 49.1 years, 43.2 years for HDs, and 45.2 years for KTx patients. Most were male; body-mass index was ~ 23.8. Anemia did not affect the efficacy of DAAs in hemodialysis, CKD, or KTx patients. Most patients achieved a rapid virologic response (RVR), and a 12- and 24-week sustained viral response. Worsening of anemia among the non-anemic group was mostly related to ribavirin therapy in hemodialysis patients (11/16 patients). Acute kidney injury in CKDs occurred more frequently within the anemic group (59.5%) compared to the non-anemic group (32.1%). For KTx, graft impairment was more common among the anemic group (7/40) compared to the non-anemic group (2/85).

CONCLUSION

Hemoglobin levels of < 10.5 g/dL prior to DAA treatment did not affect the virological response in renal patients but was associated with increased serum creatinine among KTx and those with CKD.

Effect of sofosbuvir plus daclatasvir on virological response and liver function tests as a line of treatment for HCV related cirrhosis (a prospective cohort study)

Background

Patients with chronic HCV infection are the most in need for antiviral treatment. However, patients with cirrhosis exhibit difficulty with direct antiviral agents (DAA) treatment. We intended to evaluate the virological response of DAA in HCV-related cirrhosis treatment as well as its effect on liver function tests and other laboratory tests. Our study was a prospective cohort study of 240 patients with HCV-related liver cirrhosis. Those patients were consecutively selected from Gastroenterology and Hepatology out-patient clinic at Aswan University Hospital. They were subjected to the DAA regimen (sofosbuvir 400 mg plus daclatasvir 60 mg).

Results

The study showed a rapid decrease in HCV viral load; HCV RNA was undetectable in 65% of patients on 4th week of treatment and in 88.3% of patients on 8th week of treatment. It was undetectable in 100% of patients on 12th week of treatment and remained unchanged until therapy was completed (24 weeks). The SVR (sustained virological response) was 96.3%. Other laboratory tests demonstrated that serum level of alanine aminotransferase (ALT) decreased rapidly to normal limits on 4th week of treatment and remained within normal range until 12th week post-treatment. Significant improvements in serum albumin, total bilirubin, INR, and alpha-fetoprotein (AFP) levels were observed during and after treatment. Child-Pugh score showed a significant improvement post-treatment. We also observed a significant improvement in platelet count during and after treatment.

Conclusion

The DAA regimen (sofosbuvir 400 mg plus daclatasvir 60 mg) for treatment of HCV-related liver cirrhosis can achieve satisfactory virological response (SVR more than 96%). It can lead to improvement of serum ALT, serum albumin, total bilirubin, INR, AFP, and Child-Pugh score and also increase in platelet count after treatment.

Status of Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection and Remaining Challenges

Chronic infection with hepatitis C virus is a major cause of liver disease and hepatocellular carcinoma worldwide. After the discovery of hepatitis C virus 3 decades ago, the identification of the structure of the viral proteins, combined with high-throughput replicon models, enabled the discovery and development of direct-acting antivirals. These agents have revolutionized patient care, with cure rates of more than 90%. We review the status of direct-acting antiviral therapies for hepatitis C virus infection and discuss remaining challenges. We highlight licensed compounds, discuss the potential to shorten therapy even further, and review different options for treatment failure and resistance. We also provide an overview of clinical experience with generic agents and evidence for their efficacy. Finally, we discuss the need for new drugs and outline promising targets for future therapies.