Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients

被引：364

作者：

Kamar, Nassim ^{[1
,2
,3
]}

Izopet, Jacques ^{[2
,3
,4
,5
]}

Tripon, Simona ^{[6
,7
]}

Bismuth, Michael ^{[10
]}

Hillaire, Sophie ^{[12
]}

Dumortier, Jerome ^{[13
]}

Radenne, Sylvie ^{[14
,15
]}

Coilly, Audrey ^{[16
,17
]}

Garrigue, Valerie ^{[11
]}

D'Alteroche, Louis ^{[18
]}

Buchler, Matthias ^{[19
]}

Couzi, Lionel ^{[20
]}

Lebray, Pascal ^{[8
]}

Dharancy, Sebastien ^{[21
,22
]}

Minello, Anne ^{[23
]}

Hourmant, Maryvonne ^{[24
]}

Roque-Afonso, Anne-Marie ^{[16
,17
]}

Abravanel, Florence ^{[2
,3
,4
,5
]}

Pol, Stanislas ^{[6
,7
,9
]}

Rostaing, Lionel ^{[1
,2
,3
]}

Mallet, Vincent ^{[6
,7
,9
]}

机构：

[1] Ctr Hosp Univ CHU Rangueil, Dept Nephrol Dialysis & Organ Transplantat, Toulouse, France

[2] CHU Purpan, Inst Federatif Rech Biomed Toulouse, INSERM U1043, Toulouse, France

[3] Univ Toulouse 3, F-31062 Toulouse, France

[4] CHU Purpan, Dept Virol, Toulouse, France

[5] Natl Reference Ctr Hepatitis Virus E, Toulouse, France

[6] Univ Paris 05, Inst Cochin, Sorbonne Paris Cite, CNRS,Unite Mixte Rech Sci 1016,Unite Mixte Rech 8, Paris, France

[7] Grp Hosp Cochin St Vincent de Paul, AP HP, Unite Hepatol, Paris, France

[8] Hop La Pitie Salpetriere, Dept Hepatol, Paris, France

[9] INSERM U1016, Paris, France

[10] St Eloi Hosp, Dept Hepatol, Montpellier, France

[11] Lapeyronie Hosp, Dept Nephrol & Transplantat, Montpellier, France

[12] Hop Foch, Dept Hepatol, Suresnes, France

[13] CHU Lyon, Hop Edouard Herriot, Dept Hepatol, Lyon, France

[14] Univ Lyon 1, Dept Hepatol & Liver Transplantat, CHU Croix Rousse, F-69365 Lyon, France

[15] INSERM U1052, Lyon, France

[16] Univ Paris 11, Hop Paul Brousse, AP HP, Ctr Hepatobiliaire,Unite Mixte Rech Sci 785, Villejuif, France

[17] INSERM U785, Villejuif, France

[18] Univ Hosp, Trousseau Hosp, Dept Hepatol, Tours, France

[19] Univ Hosp, Bretonneau Hosp, Dept Nephrol & Clin Immunol, Tours, France

[20] CHU Bordeaux, Dept Nephrol & Transplantat, Bordeaux, France

[21] CHU Lille, Hop Claude Huriez, Serv Malad Appareil Digestif, INSERM U995, F-59037 Lille, France

[22] Univ Nord France, Lille, France

[23] CHU Bocage, Serv Hepatogastroenterol, Dijon, France

[24] CHU Nantes, Dept Nephrol & Clin Immunol, F-44035 Nantes 01, France

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2014年 / 370卷 / 12期

关键词：

PEGYLATED INTERFERON-ALPHA; ORGAN-TRANSPLANTATION; VIROLOGICAL RESPONSE; HIV-INFECTION; CELL RESPONSE; THERAPY; PATIENT; KIDNEY;

D O I：

10.1056/NEJMoa1215246

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background There is no established therapy for hepatitis E virus (HEV) infection. The aim of this retrospective, multicenter case series was to assess the effects of ribavirin as monotherapy for solid-organ transplant recipients with prolonged HEV viremia. Methods We examined the records of 59 patients who had received a solid-organ transplant (37 kidney-transplant recipients, 10 liver-transplant recipients, 5 heart-transplant recipients, 5 kidney and pancreas-transplant recipients, and 2 lung-transplant recipients). Ribavirin therapy was initiated a median of 9 months (range, 1 to 82) after the diagnosis of HEV infection at a median dose of 600 mg per day (range, 29 to 1200), which was equivalent to 8.1 mg per kilogram of body weight per day (range, 0.6 to 16.3). Patients received ribavirin for a median of 3 months (range, 1 to 18); 66% of the patients received ribavirin for 3 months or less. Results All the patients had HEV viremia when ribavirin was initiated (all 54 in whom genotyping was performed had HEV genotype 3). At the end of therapy, HEV clearance was observed in 95% of the patients. A recurrence of HEV replication occurred in 10 patients after ribavirin was stopped. A sustained virologic response, defined as an undetectable serum HEV RNA level at least 6 months after cessation of ribavirin therapy, occurred in 46 of the 59 patients (78%). A sustained virologic response was also observed in 4 patients who had a recurrence and were re-treated for a longer period. A higher lymphocyte count when ribavirin therapy was initiated was associated with a greater likelihood of a sustained virologic response. Anemia was the main identified side effect and required a reduction in ribavirin dose in 29% of the patients, the use of erythropoietin in 54%, and blood transfusions in 12%. Conclusions This retrospective, multicenter study showed that ribavirin as monotherapy may be effective in the treatment of chronic HEV infection; a 3-month course seemed to be an appropriate duration of therapy for most patients.

引用

页码：1111 / 1120

页数：10

共 39 条

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