Pegylated interferon plus ribavirin in HIV-infected patients with recurrent hepatitis C after liver transplantation: A prospective cohort study

Identificador:  imarina:9187231

Handle: https://hdl.handle.net/20.500.11797/imarina9187231

Autores:  Castells, Lluis; Rimola, Antoni; Manzardo, Christian; Valdivieso, Andres; Luis Montero, Jose; Barcena, Rafael; Abradelo, Manuel; Xiol, Xavier; Aguilera, Victoria; Salcedo, Magdalena; Rodriguez, Manuel; Bernal, Carmen; Suarez, Francisco; Antela, Antonio; Olivares, Sergio; del Campo, Santos; Laguno, Montserrat; Fernandez, Jose R; de la Rosa, Gloria; Agueero, Fernando; Perez, Inaki; Gonzalez-Garcia, Juan; Esteban-Mur, Juan I; Miro, Jose M

Resumen:
Background & Aims: The aim of this study was to evaluate the results of treatment with pegylated interferon and ribavirin for the recurrence of hepatitis C after liver transplantation in HCV/ HIV-coinfected patients. Methods: This was a prospective, multicentre cohort study, including 78 HCV/HIV-coinfected liver transplant patients who received treatment for recurrent hepatitis C. For comparison, we included 176 matched HCV-monoinfected patients who underwent liver transplantation during the same period of time at the same centres and were treated for recurrent hepatitis C. Results: Antiviral therapy was discontinued prematurely in 56% and 39% (p = 0.016), mainly because of toxicity (22% and 11%, respectively; p = 0.034). Sustained virological response (SVR) was achieved in 21% of the coinfected patients and in 36% of monoinfected patients (p = 0.013). For genotype 1, SVR rates were 10% and 33% (p = 0.002), respectively; no significant differences were observed for the other genotypes. A multivariate analysis based on the whole series identified HIV-coinfection as an independent predictor of lack of SVR (OR, 0.17; 95% CI, 0.06-0.42). Other predictors of SVR were donor age, pretreatment HCV viral load, HCV genotype, and early virological response. SVR was associated with a significant improvement in survival: 5-year survival after antiviral treatment was 79% for HCV/HIV-coinfected patients with SVR vs. 43% for those without (p = 0.02) and 92% vs. 60% in HCV-monoinfected patients (p < 0.001), respectively. Conclusions: The response to pegylated interferon and ribavirin was poorer in HCV/HIV-coinfected liver recipients, particularly those with genotype 1. However, when SVR was achieved, survival of coinfected patients increased significantly. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.