Management of viral hepatitis in liver transplant recipients

Sequential telbivudine/lamivudine and hepatitis B immunoglobulin therapy for preventing mother-to-infant transmission of hepatitis B virus

AIM: To assess the value of sequential telbivudine/lamivudine and hepatitis B immunoglobulin (HBIG) therapy in preventing mother-to-infant transmission of hepatitis B virus (HBV).

METHODS: One hundred and seventy-eight enrolled pregnant women were divided into a telbivudine group, a lamivudine group, an HBIG group and a non-preventive group, and they were given the respective drug for preventing mother-to-infant transmission of HBV. At gestational week 12, alanine aminotransferase, total bilirubin, HBsAg, HBeAg, HBV DNA, HBV genotyping, drug resistance related mutations and natural killer cells were detected. Newborns were routinely injected with hepatitis B vaccine, and the HBIG group was additionally given HBIG 200 IU at birth, 3 and 12 wk after birth. Serum levels of HBsAg and HBeAg were detected at birth and 24 wk after birth. The safety of telbivudine and lamivudine was evaluated.

RESULTS: At 12 wk after receiving antiviral drugs, HBV DNA level was significantly reduced in the telbivudine and lamivudine groups compared with the non-preventive group (P < 0.05). No significant difference was observed in gestational age, mean weight or Apgar score of newborns in each group. In addition, no significant difference was observed in alanine aminotransferase, total bilirubin, HBsAg, HBeAg, HBV DNA, HBV genotype, drug resistance related mutations or natural killer cells in each group.

CONCLUSION: HBV DNA level can be significantly inhibited by sequential telbivudine/lamivudine and hepatitis B immunoglobulin therapy in pregnant women with high viral load, which can prevent mother-to-infant transmission of HBV.

Hepatic decompensation/serious adverse events in post-liver transplantation recipients on sofosbuvir for recurrent hepatitis C virus

AIM: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection.

METHODS: Forty-two patients were identified with recurrent HCV infection that underwent LT at least 12 mo prior to initiating treatment with a Sofosbuvir-based regimen during December 2013-June 2014. Cases were patients who experienced hepatic decompensation and/or serious adverse events (SAE) during or within one month of completing treatment. Controls had no evidence of hepatic decompensation and/or SAE. HIV-infected patients were excluded. Cumulative incidence of decompensation/SAE was calculated using the Kaplan Meier method. Exact logistic regression analysis was used to identify factors associated with the composite outcome.

RESULTS: Median age of the 42 patients was 60 years [Interquartile Range (IQR): 56-65 years], 33% (14/42) were female, 21% (9/42) were Hispanic, and 9% (4/42) were Black. The median time from transplant to treatment initiation was 5.4 years (IQR: 2.1-8.8 years). Thirteen patients experienced one or more episodes of hepatic decompensation and/or SAE. Anemia requiring transfusion, the most common event, occurred in 62% (8/13) patients, while 54% (7/13) decompensated. The cumulative incidence of hepatic decompensation/SAE was 31% (95%CI: 16%-41%). Risk factors for decompensation/SAE included lower pre-treatment hemoglobin (OR = 0.61 per g/dL, 95%CI: 0.40-0.88, P < 0.01), estimated glomerular filtration rate (OR = 0.95 per mL/min per 1.73 m², 95%CI: 0.90-0.99, P = 0.01), and higher baseline serum total bilirubin (OR = 2.43 per mg/dL, 95%CI: 1.17-8.65, P < 0.01). The sustained virological response rate for the cohort of 42 patients was 45%, while it was 31% for cases.

CONCLUSION: Sofosbuvir/ribavirin will continue to be used in the post-transplant population, including those with HCV genotypes 2 and 3. Management of anemia remains an important clinical challenge.

Antigenic composition and immunoreactivity differences between HEV recombinant capsid proteins generated from different genotypes

Appreciable variability has been observed in hepatitis E virus (HEV) serological diagnostics. Four recombinant proteins (p166s) were generated from position 452 to 617 aa of ORF2 of different HEV genotypes and used in an indirect ELISA to detect anti-HEV IgMs and IgGs in serially diluted sera of patients infected with different HEV genotypes (genotype 1, n=15; genotype 3, n=12; genotype 4, n=17). To evaluate the differences at a conformational level, 3D-structure models of p166s were predicted, and different bioinformatics tools were used to analyze the antigenic composition. With both anti-HEV IgMs and IgGs antibodies, there was a considerable variability between the four antigens immunoreactivities. In silico results revealed the region 483-533 aa with the highest antigenic potential and contains six key aa at positions 488, 489, 512, 533, 483 and 530. This immunoreactivity variation could affect diagnosis results and seroprevalence estimations and the identification in silico of a region highly antigenic would guide the development of efficient serological assays and epitope-based vaccines.