The hepatitis C virus (HCV) is a major health challenge worldwide, with approximately 170 million people chronically infected. In 2012, 24,000 liver transplants were performed in the world approximately, most of them as a result of HCV. The recurrence of this virus after liver transplantation always occurs in recipients with viremia prior to this procedure. After it, the virus colonizes the new liver and begins the hepatitis, which also evolves to cirrhosis in about a third of transplant patients.
From two years ago there are new antiviral drugs more efficient, safer and with a better security profile than classical treatment with interferon. In the study led by Dr. Forns, a combination of direct antiviral drugs (paritaprevir / ritonavir, and dasabuvir ombitasvir associated with ribavirin) was administered to 34 patients with HCV after liver transplantation. In all the patients except one the infection was cured (97% efficiency). The patient who relapsed had virus mutations that made it resistant to several of the administered antivirals.
"Another important aspect is that this combination of antivirals is very safe besides its effectiveness. The adverse effects were generally mild," explains Dr. Forns, last author of the paper.
The Hepatitis Unit led by Dr. Forns has also participated in two recently published papers in the Gastroenterology journal. In the first one, antiviral therapy -sofosbuvir and ribavirin- was administered to patients with advanced cirrhosis until the day of transplantation to prevent recurrence of the infection. 70% of them were cured, which means that it is possible to prevent HCV infection in a high proportion of transplant patients.
In another study published in the same journal, transplant patients with severe recurrence of hepatitis C were treated with ribavirin and sofosbuvir with promising result: 70% of them were also cured.
"They are, in short, three very important studies in the field of transplantation and HCV infection that open great hope for patients and professionals who are working on this field," says Dr. Forns.
These three studies were generated in the context of a close and long-standing collaboration between two groups of the Hospital Clínic / IDIBAPS and CIBEREHD the one in Viral Hepatitis led by Dr. Xavier Forns and the Liver Transplant group led by Dr. Miquel Navasa.
Article reference:
An Interferon-free Antiviral Regimen for HCV after Liver Transplantation
Paul Y. Kwo, M.D., Parvez S. Mantry, M.D., Eoin Coakley, M.D., Helen S. Te, M.D., Hugo E. Vargas, M.D., Robert Brown, M.D., M.P.H., Fredric Gordon, M.D., Josh Levitsky, M.D., Norah A. Terrault, M.D., M.P.H., James R. Burton, M.D., Wangang Xie, Ph.D., Carolyn Setze, M.S., Prajakta Badri, Ph.D., Tami Pilot-Matias, Ph.D., Regis A. Vilchez, M.D., Ph.D., and Xavier Forns, M.D.
November 11, 2014DOI: 10.1056/NEJMoa1408921