scholarly journals 2795. Clinical and Economic Impact of a Ribavirin Intervention Program in Hematopoietic Cell and Solid-organ Transplant Recipients with Respiratory Syncytial Virus Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S987-S988
Author(s):  
Emily Leonard ◽  
Rebekah Wrenn ◽  
Jennifer Saullo ◽  
Richard H Drew ◽  
Richard H Drew ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Clinical Outcomes ◽  
Acquisition Cost ◽  
Intervention Program ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Cost Avoidance ◽  
Syncytial Virus

Abstract Background While data are limited, oral ribavirin (RBV) has been shown to be a cost-effective alternative to aerosolized RBV for the treatment of respiratory syncytial virus (RSV) in immunocompromised patients with significant reductions in acquisition and administration costs. We evaluated the clinical and economic impact of an RBV intervention program at a large, academic medical center. Methods This single-center, retrospective cohort study evaluated hematopoietic cell and solid-organ transplant patients admitted to Duke University Hospital (DUH) with documented or suspected RSV receiving aerosolized and/or oral RBV from July 2013 to April 2018. The ID consult service approval requirement was initiated for aerosolized RBV beginning in October 2015. Education was done at this time to promote oral RBV as the preferred therapy for immunocompromised, RSV-infected adults and children. No restrictions or treatment protocols were in place prior to that time for either formulation. Clinical outcomes, adverse effects, and drug acquisition cost were collected. A cost-avoidance analysis was performed using DUH acquisition cost for actual and alternate RBV therapy. Results A total of 118 treatments (115 unique adult and pediatric patients) were included. Demographics were comparable between groups with and median age was 52 years in the Oral RBV and 61 years in the Aerosol RBV group. The predominant transplant type was lung (62.5% in Oral RBV and 55.6% in Aerosol RBV) followed by hematopoietic (16.7% in Oral RBV and 27% in Aerosol RBV). The median (range) duration of therapy was 4 (1–16) days for oral RBV and 5 (1–23) days for aerosolized RBV. The total cost avoidance was $2,522,915 with oral RBV. Clinical outcomes are summarized in Table 1. Conclusion In our large tertiary care center, the use of oral RBV led to substantial cost avoidance with clinical outcomes comparable to aerosolized RBV in immunocompromised patients. Larger prospective trials evaluating oral RBV for RSV treatment are warranted. Disclosures All authors: No reported disclosures.

Respiratory syncytial virus prophylaxis: A survey of pediatric solid organ transplant centers

2009 ◽  
Vol 13 (4) ◽  
pp. 451-456 ◽  
Author(s):  
Marian G. Michaels ◽  
Monica Fonseca-Aten ◽  
Michael Green ◽  
Deborah Charsha-May ◽  
Barry Friedman ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Syncytial Virus

scholarly journals Hepatitis E Virus Quasispecies and the Outcome of Acute Hepatitis E in Solid-Organ Transplant Patients

2012 ◽  
Vol 86 (18) ◽  
pp. 10006-10014 ◽  
Author(s):  
Sebastien Lhomme ◽  
Florence Abravanel ◽  
Martine Dubois ◽  
Karine Sandres-Saune ◽  
Lionel Rostaing ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Acute Hepatitis ◽  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ Transplant ◽  
First Year ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Serum Concentrations

Hepatitis E virus (HEV) infections are responsible for chronic hepatitis in immunocompromised patients, and this can evolve to cirrhosis. Like all RNA viruses, HEV exists as a mixture of heterogeneous viruses defining quasispecies. The relationship between the genetic heterogeneity described as a quasispecies, cytokine secretion, and the outcome of acute hepatitis in immunocompromised patients remains to be elucidated. We cloned and sequenced the region encoding the M and P capsid domains of HEV from eight solid-organ transplant (SOT) patients with acute HEV infection who subsequently cleared the virus and from eight SOT patients whose infection became chronic. We analyzed the cytokines and chemokines in the sera of these SOT patients by multianalyte profiling. The nucleotide sequence entropy and genetic distances were greater in patients whose infections became chronic. A lowerKa/Ksratio was associated with the persistence of HEV. The patients who developed chronic infection had lower serum concentrations of interleukin-1 (IL-1) receptor antagonist and soluble IL-2 receptor. Increased concentrations of the chemokines implicated in leukocyte recruitment to the liver were associated with persistent infection. Those patients with chronic HEV infection and progressing liver fibrosis had less quasispecies diversification during the first year than patients without liver fibrosis progression. Great quasispecies heterogeneity, a weak inflammatory response, and high serum concentrations of the chemokines involved in leukocyte recruitment to the liver in the acute phase were associated with persistent HEV infection. Slow quasispecies diversification during the first year was associated with rapidly developing liver fibrosis.

Immunocompromised patients, including HIV-positive patients

2016 ◽  
Author(s):  
Dr Sanjay Bhagani ◽  
Dr Nicholas Easom ◽  
Dr Sanjay Bhagani ◽  
Dr Nicholas Easom ◽  
Dr Nicholas Easom
Keyword(s):  
Organ Transplant ◽  
Immune Dysfunction ◽  
Solid Organ Transplant ◽  
Hiv Positive ◽  
Post Exposure Prophylaxis ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Secondary Immunodeficiency ◽  
Exposure Prophylaxis ◽  
Prevention Of Hiv

Chapter 13 discusses immunocompromised patients, including HIV-positive patients, HIV and other causes of immunodeficiency, infections in the HIV-infected patient, post-exposure prophylaxis (PEP) for prevention of HIV infection, non-HIV causes of immunodeficiency, secondary immunodeficiency in malignancy or post-chemotherapy, immune dysfunction and systemic illness, solid organ transplant, and immunosuppressive therapy.

Sign in / Sign up

Export Citation Format

Share Document