AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.
Université Paris-Sud, Villejuif, France.
Transplantation. 2018 Jan;102(1):119-126. doi: 10.1097/TP.0000000000001928.
A recurrence of hepatitis C virus (HCV) after liver transplantation affects survival in human immunodeficiency virus (HIV)/HCV coinfected patients. This study assessed the efficacy and safety of sofosbuvir (SOF)-based regimens in HIV/HCV coinfected patients after liver transplantation.
Twenty-nine HIV/HCV coinfected transplanted patients receiving tacrolimus-, cyclosporine-, or everolimus-based immunosuppressive therapy were enrolled in the Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation cohort. Their antiviral treatment combined SOF, daclatasvir with or without ribavirin (n = 10/n = 6), or SOF, ledipasvir with or without ribavirin (n = 2/n = 11).
The median delay between liver transplantation and treatment initiation was 37.5 months (interquartile range [IQR], 14.4-99.2). The breakdown of HCV genotypes was G1, 22 patients (75.9%); G3, 3 patients (10.3%); and G4, 4 patients (13.8%). The treatment indications were HCV recurrence (≥ F1 n = 23) or fibrosing cholestatic hepatitis (n = 6). Before starting SOF, the HCV viral load and CD4 count were 6.7 log10 IU/mL (IQR, 5.9-7.2) and 342 cells/mm (IQR, 172-483), respectively. At week 4, the HCV viral load was less than 15 IU/mL in 12 (42.9%) patients. The overall sustained virological response 12 was 96.6%. No significant drug-drug interactions were observed.
SOF-based treatment regimens produced excellent results in HIV/HCV coinfected patients after liver transplantation, suggesting an important change in their prognosis.
丙型肝炎病毒（HCV）在肝移植后的复发会影响人类免疫缺陷病毒（HIV）/HCV 合并感染患者的生存。本研究评估了索磷布韦（SOF）为基础的方案在 HIV/HCV 合并感染肝移植患者中的疗效和安全性。
29 例接受他克莫司、环孢素或依维莫司为基础的免疫抑制治疗的 HIV/HCV 合并感染移植患者被纳入蛋白酶抑制剂在病毒性 C 肝移植中的同情使用队列。他们的抗病毒治疗联合 SOF、达拉他韦加或不加利巴韦林（n = 10/n = 6）或 SOF、雷迪帕韦加或不加利巴韦林（n = 2/n = 11）。
肝移植与治疗开始之间的中位时间延迟为 37.5 个月（四分位距 [IQR]，14.4-99.2）。HCV 基因型的分布为 G1，22 例（75.9%）；G3，3 例（10.3%）；G4，4 例（13.8%）。治疗指征为 HCV 复发（≥F1 n = 23）或纤维性胆汁性肝炎（n = 6）。开始 SOF 治疗前，HCV 病毒载量和 CD4 计数分别为 6.7 log10 IU/mL（IQR，5.9-7.2）和 342 个细胞/mm（IQR，172-483）。第 4 周时，12 例（42.9%）患者的 HCV 病毒载量小于 15 IU/mL。总的持续病毒学应答率为 96.6%。未观察到明显的药物-药物相互作用。
SOF 为基础的治疗方案在 HIV/HCV 合并感染肝移植患者中取得了极好的效果，提示其预后发生了重要变化。
