DAAs safe, effective for heart transplant recipients with HCV
Direct-acting antiviral therapies Harvoni and Daklinza plus Sovaldi were both safe and highly effective among patients with chronic hepatitis C virus infection who received heart transplants, researchers in Taiwan reported.
“The reported prevalence of HCV infection among heart transplant recipients ranges from 7% to 18%,” Jia-Horng Kao, MD, of the department of internal medicine at National Taiwan University Hospital, Taipei, and colleagues wrote. “The use of [interferon (IFN)-free] direct-acting antiviral agents (DAAs) has confirmed the excellent efficacy and safety for ordinary patients with chronic HCV infection. Till now, there are no case series to evaluate the effectiveness and safety of IFN-free DAAs for heart transplant recipients with chronic HCV infection.”
The researchers enrolled 12 patients aged 20 years and older who had chronic HCV infection and underwent heart transplantation. Patients received a fixed-dose combination of Harvoni (ledipasvir 90 mg/sofosbuvir 400 mg, Gilead Sciences) once daily for 12 weeks if they had HCV genotype 1, and 400 mg of Sovaldi (sofosbuvir, Gilead Sciences) plus 60 mg of Daklinza (daclatasvir, Bristol-Myers Squibb) once daily for 12 weeks for HCV genotypes 2 or 6. The main outcome was SVR12.
The patients’ median age was 55 years, and most (n = 7; 58.3%) were male. Seven had HCV genotype 1, four had genotype 2 and one had genotype 6, the researchers wrote.
All patients achieved SVR12, Kao and colleagues reported (100%; 95% CI, 75.8%-100%). There were no serious adverse events, although eight (66.7%) experienced at least one adverse event. No patients relapsed during the 12 weeks of follow-up after therapy ended.
In an accompanying editorial, Ethan M. Weinberg, MD, and K. Rajender Reddy, MD, both professors of medicine at the University of Pennsylvania Perelman School of Medicine, wrote that, “unfortunately, with the increasing numbers of young Americans dying from opiate overdoses, the number of potential organ donors with acute HCV has continued to increase.”
Because of the large numbers of organs previously disqualified from transplantation because of HCV infection, Reddy and Weinberg wrote, transplant centers will likely increase the use of HCV-positive organs in the near future.
“Most importantly, though, and on a global scale, while the transplant recipients benefit from the availability of HCV-positive organs, it is incumbent upon the public health and health care provider community to become more engaged in education and intervention through harm-reduction strategies to prevent HCV transmission and their consequences in young individuals.” – by Andy Polhamus
Disclosures: Weinberg reports no relevant financial disclosures. Reddy reports research support to the University of Pennsylvania from AbbVie, Bristol-Myers Squibb, Gilead Sciences and Merck, as well as advisory roles with AbbVie, Gilead Sciences and Merck. The researchers report no relevant financial disclosures.