BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.
BACKGROUND: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. METHODS: 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. RESULTS: 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. CONCLUSION: An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.
Authors: Yijin Wang; Wenshi Wang; Lei Xu; Xinying Zhou; Ehsan Shokrollahi; Krzysztof Felczak; Luc J W van der Laan; Krzysztof W Pankiewicz; Dave Sprengers; Nicolaas J H Raat; Herold J Metselaar; Maikel P Peppelenbosch; Qiuwei Pan Journal: Antimicrob Agents Chemother Date: 2016-04-22 Impact factor: 5.191
Authors: Jeffrey J Germer; Irina Ankoudinova; Yevgeniy S Belousov; Walt Mahoney; Chen Dong; Jihong Meng; Jayawant N Mandrekar; Joseph D Yao Journal: J Clin Microbiol Date: 2017-02-22 Impact factor: 5.948
Authors: Mira Choi; Jörg Hofmann; Anja Köhler; Bo Wang; Claus-Thomas Bock; Eckart Schott; Petra Reinke; Peter Nickel Journal: Transplant Direct Date: 2018-02-02