scholarly journals Outcomes of liver transplantation in the era of modern antiviral therapy for hepatitis C

2021 ◽  
Vol 23 (1) ◽  
pp. 15-23
Author(s):  
K. Yu. Kokina ◽  
Yu. O. Malinovskaya ◽  
Ya. G. Moysyuk
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Antiviral Treatment ◽  
Virologic Response ◽  
Decompensated Cirrhosis ◽  
Optimal Timing ◽  
Group 2 ◽  
Direct Acting ◽  
End Stage

The emergence of direct-acting antivirals (DAAs) has become the basis for a new potential treatment for chronic hepatitis C (CHC) in patients with decompensated cirrhosis, who previously had no other alternative than liver transplantation (LT). However, optimal timing of antiviral therapy (AVT) remains an issue. Objective: to present a spectrum of clinical outcomes in LT waitlisted patients with HCV-related cirrhosis, who received and did not receive DAA therapy. Materials and methods. Enrolled for the study were 49 waitlisted patients with HCV-related end-stage liver diseases. The patients were divided into 2 groups: Group 1 included 40 patients who received DAA therapy before LT, while Group 2 consisted of 9 patients who did not receive antiviral treatment while on the LT waiting list. Results. The sample was represented in most cases by patients who had MELD/Na score <20. Only six had MELD/Na score >20, but <25. At the time of analysis, 38 patients had reached 12 weeks post AVT. Of these, 35 (92.1%) had sustained virologic response (SVR). Of these, 51.4% (n = 18) of cases showed decreased MELD/Na. There were no changes in 22.9% (n = 8). Increased MELD/Na was noted in 25.7% (n = 9). In 42.8% (n = 15) of cases, sustained elimination of HCV infection led to delisting. Among patients without SVR, increased MELD/Na was observed in all cases (n = 3). In the non-AVT group, one patient showed improved liver function (11.1%); in the rest, MELD/Na either remained stable or continued to increase - 44.5% (n = 4). A comparison of the frequency of deaths depending on AVT showed statistically significant differences (p < 0.001, V = 0.728). Among the non-AVT patients, the likelihood of waitlist death increased 66.5 times (95% CI: 7.99-554). Conclusion: DAA therapy carries significant advantages for waitlisted patients with MELD/Na score <25.

New Epidemiologic Data Regarding Hepatitis C Virus Infection in Romania

2017 ◽  
Vol 26 (4) ◽  
pp. 381-386
Author(s):  
Mircea Manuc ◽  
Carmen M. Preda ◽  
Corneliu P. Popescu ◽  
Cristian Baicuș ◽  
Theodor Voiosu ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Users ◽  
Antiviral Agent ◽  
Virologic Response ◽  
Advanced Fibrosis ◽  
Direct Acting Antiviral ◽  
Genotype 1B ◽  
Direct Acting ◽  
End Stage

Background & Aims: Literature data suggest that HCV genotype-1b is present in 93-99% of the Romanian patients infected with hepatitis C virus (HCV). We present the genotyping tests recently performed on patients with HCV and advanced fibrosis eligible for the Direct-Acting Antiviral (DAA) therapy, as well as the prevalence of these cases across Romania.Methods: The genotyping method was performed on 7,421 HCV patients with advanced fibrosis. The detection method was automatic real time PCR platform M2000 (Abbott). Every subject was introduced into a database including age, sex, county and address.Results: Genotype 1b was almost exclusively present: 7,392/7,421 (99.6%). Genotype 1b patients were 19.6% from Bucharest, 49% were males, with a median age of 60 years. Genotype non-1b was encountered in 29/7,421 subjects (0.4%), 62% were males, 69% from Bucharest and the median age was 52 years. Most of the subjects (75%) were in the 6th and 7th age decade. The prevalence of these cases varied significantly across Romanian counties: the highest was in Bucharest (61.3/105), Bihor (47/105), Iasi (46/105) and Constanța (43/105), and the lowest in Ilfov (2.8/105), Harghita (3.7/105), Covasna (5.4/105) and Maramureș (8.8/105) (p<0.001).Conclusions: Genotype 1b is encountered in 99.6% of patients with chronic hepatitis C and advanced fibrosis from Romania. The presence of genotypes non-1b is more common in Bucharest, in males and at a younger age. There are significant differences regarding the distribution of these cases across Romania: the highest rates are in Bucharest, Bihor, Iasi and Constanta.Abbreviations: BMI: body mass index; DAA: direct-acting antiviral agent; GT: genotype; HBV: hepatitis B virus; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; IDU: intravenous drug users; MELD: model for end stage liver disease; NASH: non-alcoholic steatohepatitis; SVR; sustained virologic response.

Changes in Serum Level of Autotaxin with Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Hussein Abdelwahab ◽  
Shereen Abou Bakr Saleh ◽  
Ghada Abdelrahman Ahmed ◽  
Asmaa Mady Gomaa Mady
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Serum Level ◽  
Antiviral Therapy ◽  
Chronic Hepatitis C ◽  
Antiviral Treatment ◽  
Post Treatment ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Hepatitis C virus virus is global health burden and major health hazard in Egypt, since the virus is the etiological factor of chronic hepatitis. Hepatitis C virus (HCV) accounts for approximately 15%-20% cases of acute hepatitis. After acute infection, around 50% to 80% of HCV patients will develop chronic infection. Approximately, HCV infects 170 million individuals worldwide). Chronic hepatitis C (CHC) patients are at high risk to develop lifethreatening complications, including cirrhosis in 20% of cases and hepatocellular carcinoma. Objectives The aim of this study was to validate Changes in serum level of autotaxin in patients with chronic hepatitis C before and after antiviral treatment. Patients and methods This study was designed as a prospective observational cohort study to evaluate Changes in serum levels of autotaxin with direct-acting antiviral therapy in patients with chronic hepatitis C before (baseline) and after (sustained virologic response week 12) treatment. This prospective study was conducted on 48 chronic HCV infected patients eligible for antiviral treatment with direct acting antivirals, agreeable to regular follow up, recruited from Hepatology and virology outpatient clinic at DMNI (Damanhour Medical National Institute) during the period from September 2018 till Mars 2019. Results This study showed that Autotaxin level significantly decreased from baseline to 12 weeks post-treatment. ATX therefore represents a novel non-invasive biomarker for liver fibrosis and a prognostic indicator of disease activity. Conclusion Serum Autotaxin was found to be higher in chronic hepatitis c and ATX levels became significantly decreased from baseline to 12 weeks post-treatment with direct acting antiviral drugs in patients achieving a SVR.

Hepatitis C “true” late relapse beyond 48 weeks of sustained virologic response after direct acting antiviral therapy

2017 ◽  
Vol 66 (4) ◽  
pp. 862-863 ◽  
Author(s):  
Thomas Klag ◽  
Julia Dietz ◽  
Christoph R. Werner ◽  
Julia M. Schwarz ◽  
Ulrich M. Lauer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Antiviral Therapy ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Late Relapse ◽  
Direct Acting Antiviral ◽  
Direct Acting

scholarly journals Sustained Virologic Response Rates of Direct Acting Antivirals in HIV Coinfected Hepatitis C Patients and Its Effect on Liver Fibrosis

2020 ◽  
Vol 3 (2) ◽  
pp. 01-07
Author(s):  
Dora Lebron
Keyword(s):  
Hepatitis C ◽  
Real World ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Hiv Care ◽  
Secondary Outcome ◽  
Direct Acting Antivirals ◽  
Fibrosis Regression ◽  
Direct Acting ◽  
End Stage

Background: Hepatitis C virus (HCV) is an important cause of chronic hepatitis with necroinflammation and fibrosis resulting in end stage liver disease and hepatocellular carcinoma. Direct acting antivirals (DAAs) are newer agents that directly interfere with the HCV lifecycle and result in high rates of sustained virologic response (SVR). We evaluated if treatment with DAAs in a real-world setting is as successful in HCV/HIV coinfected patients as it is in HCV monoinfected patients, and if some degree of fibrosis regression can be observed after completion of therapy in both groups. Methods: We retrospectively reviewed data from HCV monoinfected and HCV/HIV coinfected patients who received treatment from 2014-2016 at the East Carolina University Infectious Diseases clinic. The primary outcome was to compare completion and sustained virologic response (SVR) rate at either 12 or 24 weeks between HCV monoinfected patients and HCV/HIV coinfected patients. The secondary outcome was to assess regression of fibrosis at either 12 or 24 weeks after completion of therapy, defined as one METAVIR stage improvement in their FibroSure™, a noninvasive biochemical test to estimate the stage of fibrosis. Results: There were 41 patients in each group. Compared to the coinfected group, patient no show rate was higher in the monoinfected group (p=0.0346). In the HCV monoinfected group, 25 (93%) achieved either SVR 12 or 24. Two patients were non-compliant and had detectable viral load on evaluation at week 12. In the HCV/HIV coinfected group, 37 patients achieved SVR (p=0.0039). One patient in the coinfected group did not complete therapy but achieved SVR. In terms of fibrosis, 12/18 (67%) in the monoinfected group demonstrated improvement in at least 1 Metavir stage and 6/18 (33%) had no change. In the coinfected group, 8/16 (50%) patients demonstrated an improvement in FibroSure™ stage, 5/16 (31%) had no change, and 3/16 (19%) had worsening fibrosis according to FibroSure™ stage, (p=0.4867). Conclusions: In this small, real-world cohort, HCV/HIV coinfected patients treated with DAAs had higher completion and SVR rates than HCV monoinfected patients. Treatment failures in the monoinfected group were all linked to non-adherence, whereas, more coinfected patients achieved SVR, likely related to the fact that they were regularly engaged in routine HIV care. Fibrosis regression based on FibroSure™ was observed more in monoinfected patients than those with coinfection. Although not statistically significant, at least 50% of the patients in each group had regression of fibrosis.

scholarly journals THERAPY OF RECURRENT HEPATITIS C AFTER TRANSPLANTATION OF THE LIVER WITH DIRECT ACTING ANTI-HEPATITIS C VIRUS DRUGS: EXPERIENCE OF THREE RUSSIAN CENTERS

2018 ◽  
Vol 23 (1) ◽  
pp. 4-14
Author(s):  
Vladimir E. Syutkin ◽  
E. N Bessonova ◽  
M. N Davydenko
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
De Novo ◽  
Virologic Response ◽  
Resistance Mutations ◽  
Virus Genotype ◽  
Serious Adverse Events ◽  
Recurrent Hepatitis ◽  
Recurrent Hepatitis C ◽  
Direct Acting

The results of a retrospective analysis of the experience of three Russian regional liver transplantation centers in relation to antiviral therapy of recurrent hepatitis C in liver recipients are presented. There were studied six different therapeutic schedules with direct antiviral drugs (DAVD) administered in 91 patients. The frequency of the persistent virologic response in 12 weeks after the completion of therapy (PVR12) amounted to 92.3%. In recipients, the use of a combination of sofosbuvir and daclatasvir seems to be the most promising as following its administration relapses observed in only 3 out of the 57 recipients were associated with drug resistance mutations to NS5A inhibitors. There were no serious adverse events related to the use of DAVD. The frequency of the reactivation of HBV infection against the background of DAVD therapy in liver recipients did not exceed the previously reported frequency of de novo hepatitis B in non-endemic regions. In recurrent hepatitis C patients after the liver transplantation effects of both the virus genotype, the pronouncement of graft fibrosis and the addition of ribavirin, on the frequency of SVO12 have not been revealed.

scholarly journals Impact of direct-acting antiviral therapy on the need for liver transplantation related to hepatitis C in Germany

2018 ◽  
Vol 69 (4) ◽  
pp. 982-984 ◽  
Author(s):  
Kerstin Herzer ◽  
Guido Gerken ◽  
Daniela Kroy ◽  
Frank Tacke ◽  
Julius Plewe ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Direct Acting Antiviral ◽  
Direct Acting

A Laparoscopic Splenectomy Allows the Induction of Antiviral Therapy for Patients with Cirrhosis Associated with Hepatitis C Virus

2011 ◽  
Vol 77 (2) ◽  
pp. 174-179
Author(s):  
Yoshinobu Shigekawa ◽  
Kazuhisa Uchiyama ◽  
Katsunari Takifuji ◽  
Masaki Ueno ◽  
Takashi Hama ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Laparoscopic Splenectomy ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Virologic Response ◽  
Median Hospital Stay ◽  
Postoperative Death ◽  
Median Hospital

It is difficult to treat patients with cirrhosis-associated hepatitis C with pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related hypersplenism. Both safety and clinical efficacy were retrospectively analyzed for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to December 2007. A total of 35 patients with cirrhosis associated with hepatitis C virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all patients had thrombocytopenia, which was a contraindication for antiviral therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and Child C in one patient. All 35 patients increased platelet count from 48,000 ± 15,000 to 155,000 ± 55,000/μl ( P < 0.0001) after LS. The median hospital stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5 to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had partial therapy. Of these, nine had a sustained virologic response. A laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C virus can be performed safely and allows induction of antiviral treatment.

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