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An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients.
Transplantation. 2015 Oct; 99(10):2124-31.T

Abstract

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+Show Affiliations

1 Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France. 2 INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France. 3 Université Paul Sabatier, Toulouse, France. 4 Laboratory of Virology, CHU Purpan, Toulouse, France. 5 Department of Thoracic Surgery and Lung Transplantation, CHU Rangueil-Larrey, Toulouse, France. 6 Pediatric Hepatology, Hôpital des enfants, Toulouse, France. 7 Laboratory of Toxicology, CHU Purpan, Toulouse, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26214817

Citation

Kamar, Nassim, et al. "An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients." Transplantation, vol. 99, no. 10, 2015, pp. 2124-31.
Kamar N, Lhomme S, Abravanel F, et al. An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients. Transplantation. 2015;99(10):2124-31.
Kamar, N., Lhomme, S., Abravanel, F., Cointault, O., Esposito, L., Cardeau-Desangles, I., Del Bello, A., Dörr, G., Lavayssière, L., Nogier, M. B., Guitard, J., Ribes, D., Goin, A. L., Broué, P., Metsu, D., Sauné, K., Rostaing, L., & Izopet, J. (2015). An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients. Transplantation, 99(10), 2124-31. https://doi.org/10.1097/TP.0000000000000850
Kamar N, et al. An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients. Transplantation. 2015;99(10):2124-31. PubMed PMID: 26214817.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients. AU - Kamar,Nassim, AU - Lhomme,Sebastien, AU - Abravanel,Florence, AU - Cointault,Olivier, AU - Esposito,Laure, AU - Cardeau-Desangles,Isabelle, AU - Del Bello,Arnaud, AU - Dörr,Gaëlle, AU - Lavayssière,Laurence, AU - Nogier,Marie Béatrice, AU - Guitard,Joelle, AU - Ribes,David, AU - Goin,Anne Laure, AU - Broué,Pierre, AU - Metsu,David, AU - Sauné,Karine, AU - Rostaing,Lionel, AU - Izopet,Jacques, PY - 2015/7/28/entrez PY - 2015/7/28/pubmed PY - 2016/1/5/medline SP - 2124 EP - 31 JF - Transplantation JO - Transplantation VL - 99 IS - 10 N2 - 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. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/26214817/An_Early_Viral_Response_Predicts_the_Virological_Response_to_Ribavirin_in_Hepatitis_E_Virus_Organ_Transplant_Patients_ L2 - https://doi.org/10.1097/TP.0000000000000850 DB - PRIME DP - Unbound Medicine ER -