An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Kamar, Nassim; Lhomme, Sebastien; Abravanel, Florence; Cointault, Olivier; Esposito, Laure; Cardeau-Desangles, Isabelle; Del Bello, Arnaud; Dörr, Gaëlle; Lavayssière, Laurence; Nogier, Marie Béatrice; Guitard, Joelle; Ribes, David; Goin, Anne Laure; Broué, Pierre; Metsu, David; Sauné, Karine; Rostaing, Lionel; Izopet, Jacques
• Is Part Of: Transplantation. Volume 99:Issue 10(2015)
• Publication Date: 2015-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000850
• Languages: English
• ISSNs: 0041-1337

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>Ribavirin is efficient at treating chronic hepatitis E virus infection in solid-organ transplant patients. However, the early kinetics of viral replication under therapy and the impact of immunosuppressant regimens on viral replication are unknown: thus, determining the aim of our study.</p> </sec> <sec> <title>Methods</title> <p>Thirty-five patients with a solid-organ transplant and chronic hepatitis E virus infection were given ribavirin for 3 months. The hepatitis E virus (HEV) RNA concentrations were determined before treatment, at days 7, 15, and 21 and at months 1, 2, and 3 during therapy and after ribavirin cessation.</p> </sec> <sec> <title>Results</title> <p>A sustained virological response (SVR) occurred in 63%. Decreased viral concentration within the first week post-ribavirin therapy was an independent predictive factor for SVR, and a decreased HEV concentration of 0.5 log copies/mL or greater had an 88% positive predictive value. No correlation between ribavirin trough level on day 7 or at month 2 with a virological response or an SVR was observed. Before therapy, HEV RNA concentration was significantly greater in patients receiving mechanistic target of rapamycin inhibitor-based immunosuppression compared to patients given calcineurin inhibitors. The use of mycophenolic acid did not impact on the response to ribavirin.</p> </sec> <sec> <title>Conclusion</title> <p>An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.</p> </sec> </abstract>