IMPACT OF ANTIHCV THERAPY AFTER LIVER TRANSPLANTATION LT in HIVHCV COINFECTED PATIENTS

1
IMPACT OF ANTI-HCV THERAPY AFTER LIVER
TRANSPLANTATION (LT) in HIV-HCV CO-INFECTED
PATIENTS

• JC Duclos-Vallée, C Feray, M Sebagh, D Vittecoq,
  E Teicher, AM Roque-Afonso, M Gigou,
  E Dussaix, C Guettier, D Azoulay, R Adam,
  P Ichaï, F Saliba, B Roche, D Castaing, H
  Bismuth and D Samuel

CENTRE HEPATO-BILIAIRE HÔPITAL PAUL BROUSSE
2
Controversies

• LT in HIV-HCV co-infected patients is feasible
• but
• Recurrence of HCV infection
• may lead to graft failure

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Description of Acute Chronic hepatitis C on the
liver graft and response of anti-HCV antiviral
therapy
Duclos-Vallée et al. J Hepatol 2005
4
AIMTo describe

• The Impact of anti-HCV therapy
• after LT in HIV-HCV co-infected patients

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Patients Characteristics (1)
6
OLT Characteristics (2)
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RESULTS

• 18 patients alive
• 5 patients died
• - M2 acute pancreatitis
• - M2 cerebral haemorrhage
• - M4 hepatocellular insufficiency
• - M11 pancreas adenocarcinoma
• - M22 hepatocellular insufficiency

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Secondary effect of anti-HCV therapy

• Anti HCV therapy was stopped in 5 patients
• Pancreatitis n1
• Lethal lactic acidosis n1
• Intense Asthenia n3

14/23 (61) treated
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14
12
10
8
F2 to F1 F4 to F2
6
n14
Sustained Respn1 Complete Resp
n2 Partial Resp n1
4
2
n4
n2
0
Biochemical Response
Histological Response
Virological Response
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Patient 1 genotype 1b
D12 acute hepatitis
M6 A3F4
M48 A1F3
IU/L
log10
900
9
8
700
7
6
500
5
4
300
3
2
100
1
0
0
months
J0
J4
S1
M1
M3
M6
M12
M18
M24
M48
S2-3
STA-NEV-NELF
D4T-NELF-EF
M6
M20
IFN 1.5 MU X 3W-PegIFN 50 g 600mg ribavirin/day
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Patient 7. Genotype 1a
M1Acute lobular hepatitis Acute rejection 1.1.1
M4 A3F1 microvesicular steatosis
Log 10
IU/L
400
7,2
M12 A2F1
350
M8 A3F2
300
7
250
6,6
ALT
200
6,4
HCV
150
6,2
100
6
50
5,8
0
5,6
months
J0
J4
S1
M1
M2
M4
M6
M8
M10
S2-3
AZT- 3TC-DDI
AZT- 3TC-NELF
DDI-TNF-Lop/RTV
ABC-TNF-Lop/RTV
M10 IFN PEG 80 g/W Ribavirin800 mg/day
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Effect of antiviral therapy
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CONCLUSIONS

• Liver transplantation in HIV-HCV co-infected
  patients and administration of anti-HCV therapy
  are feasible
• However severe and lethal toxicity may occur
• A biochemical and an histological response could
  be obtained
• Anti-HCV therapy must be tried for all patients
  as early as possible