Merli Marco, Rossotti Roberto, Travi Giovanna, Ferla Fabio, Lauterio Andrea, Angelini Zucchetti Teresa, Alcantarini Chiara, Bargiacchi Olivia, De Carlis Luciano, Puoti Massimo
Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Transpl Infect Dis. 2019 Dec;21(6):e13165. doi: 10.1111/tid.13165. Epub 2019 Sep 15.
Direct-acting antivirals (DAAs) demonstrated high efficacy and safety even in the post-liver transplant (LT) setting and in HIV-infected patients, but data are very limited in the early post-LT period with the most recently available DAA. Two HIV/HCV-coinfected LT recipients (both grafts from HIV/HCV-negative donors) experienced early HCV recurrence with severe hepatitis and were treated with sofosbuvir/velpatasvir for 12 weeks. Unfortunately, both patients failed: one (genotype 4d) showed virological breakthrough at week 3 with resistance-associated substitutions (RASs) for both NS5A and NS5B, while the other (genotype 1a) experienced virological relapse without RAS. Both progressed to fibrosing cholestatic hepatitis and were successfully retreated with glecaprevir/pibrentasvir for 16 weeks achieving sustained virological response. The higher prevalence of RAS in experienced genotype 4 patients and the long time to viral suppression observed in subjects with fibrosing cholestatic hepatitis should be taken into account, considering longer treatment duration to increase the chances of achieving sustained virological response.
直接作用抗病毒药物（DAAs）即使在肝移植（LT）后以及HIV感染患者中也显示出高效性和安全性，但在LT后早期使用最新的DAAs的数据非常有限。两名HIV/HCV合并感染的LT受者（均接受来自HIV/HCV阴性供者的移植物）出现早期HCV复发并伴有严重肝炎，接受索磷布韦/维帕他韦治疗12周。不幸的是，两名患者均治疗失败：其中一名（基因4d型）在第3周出现病毒学突破，NS5A和NS5B均出现耐药相关置换（RASs），而另一名（基因1a型）出现病毒学复发但无RAS。两人均进展为纤维化胆汁淤积性肝炎，并成功接受glecaprevir/pibrentasvir再治疗16周，实现持续病毒学应答。考虑到经验丰富的基因4型患者中RAS的较高发生率以及在纤维化胆汁淤积性肝炎患者中观察到的病毒抑制时间较长，应考虑延长治疗时间以增加实现持续病毒学应答的机会。
