EFFICIENCY OF DAA ON HCV-INFECTED KIDNEY TRANSPLANT PATIENTS AT CHO RAY HOSPITAL – VIETNAM


EFFICIENCY OF DAA ON HCV-INFECTED KIDNEY TRANSPLANT PATIENTS AT CHO RAY HOSPITAL – VIETNAM


Tran Xuan Truong1, Thai Minh Sam2, Pham Thi Ngoc Thao3, Tran Ngọc Sinh4

1Chief of General Internal Medicin department – Cho Ray hospital – South Vietnam
2Chief of Uro-Neprologic department – Cho Ray hospital – South Vietnam
3Vice Director of Choray hospital-South VietNam
4Uro-Neprology Professor of University of Medical and Pharmaceutical  – South Vietnam


Open Journal of Gastroenterology and Hepatology

Purposes:To evaluate the efficiency of DAA (Direct Antiviral Agent), in particular sofosbuvir, ledipasvir in Hepatitis C treatment for patients with kidney transplants. Take note in the side effects and drug interactions during the treatment processes.

Method:Intervention, prospective, cohort, case studies, non-randomized, open on to all kidney transplant cases with chronic Hepatitis C tested positive HCV RNA (+); the patients from the cases above had agreed to be the research’s subjects from 11/2015 to 8/2018 at Cho Ray hospital. Two regimens Sofosbuvir/Ribavirin and Sofosbuvir/Ledipasvir have been used for treatments, which depend on HCV genotype and liver cirrhosis levels.

Results:In 440 patients who had been observed after kidney transplants, 44 cases anti HCV (+), 29 cases HCV RNA(+) and 4 cases HBV/HCV Confection. There were 15 cases with chronic Hepatitis C participated in study. Males made up 66.6% of the group with the average age 49± 7.06 yrs. There were 6.7% of them not taking full-course treatments. 80% of the patients were infected with only C virus, while 20% of the patients were co-infected with B and C virus. 40% of them had histories of previous blood transfusions. The ratio of patients with elevated liver enzymes was 33.3%. Genotype 1 (a and b) was 33.3%, genotype 2 was 6.7%, genotype 6 was 53.3% and 6.7% unidentifiable genotype. There were 2 cases which were treated with Sofosbuvir/Ribavirin regimen and 13 cases which were treated with Sofosbuvir/Ledipasvir regimen.
Rapid virologic response (RVR) is 100%. Sustained virologic response (SVR) within 12 weeks and 24 weeks is 100%. Relapse ratio 0%. In regimen using Sofosbuvir / Ledipasvir, the side effects are mild and transient, including skin irritation, digestive disorders which account for 7.7%. In regimen using Sofosbuvir / Ribavirin, side effects including severe anemia, fatigue, loss of appetite related to Ribavirin occur in 50% of cases (1/2) which lead to stopping treatment termination after 10 weeks and being replaced with treatment regimens using sofosbuvir / daclatasvir with good results. No major interactions are recorded when being used simultaneously with immunosuppressive drugs such as Prograf, Sandimmum Neoral, Mycophenolate Mofetil, Prednisone in this research. No renal failure occurs. Liver enzymes are improved during and after treatment. There is improvement scale of fibroscan after treatment.

Conclusion: Sofosbuvir/ Ledipasvir regimen have proven their effectiveness in treating chronic Hepatitis C genotype 1, 2 and 6 on kidney-transplanted patient, with RVR at 100%, SRV 12 and SRV 24 at 100%. Sofosbuvir/ ribavirin regimen have proven to be effective in eliminating virus and be economical in treating chronic hepatitis C genotype 2, however, the anemia side effect of ribavirin need to be considered in case it become serious and now  the first-line regimens are Sofosbuvir/daclatasvir or sofosbuvir/ Velpatasvir. There is improvement of hepatic fibrosis after treatment DAA.


Keywords: kidney transplantation, hepatitis C, HCV, DAA, sofosbuvir, ledipasvir, ribavirin, Vietnam.

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How to cite this article:
Tran Xuan Truong, Thai Minh Sam, Pham Thi Ngoc Thao, Tran Ngọc Sinh. EFFICIENCY OF DAA ON HCV-INFECTED KIDNEY TRANSPLANT PATIENTS AT CHO RAY HOSPITAL – VIETNAM. Open Journal of Gastroenterology and Hepatology, 2019, 2:13. DOI: 10.28933/ojgh-2019-08-1806


References:

1. “NIH consensus statement on management of hepatitis C: 2002,” NIH Consens State Sci Statements, vol. 19, no. 3, pp. 1–46, 2002.
2. AASLD and IDSA 2015 .”Recommendations for Testing, Managing, and Treating Hepatitis C “.
3. AASLD-IDSA -2016. “Recommendations for Testing, Managing, and Treating Hepatitis C”
4. D. Sawinski,N. Kaur, A. Ajeti,J. Trofe-Clark,M. Lim,M. Bleicher,S. Goral,K. A. Forde,R. D. Bloom. 2016. “Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents” . American Journal of TransplantationVolume 16, Issue 5,May 2016,Pages 1588–1595
5. European Association for the Study of the Liver. 2015 “EASL Recommendations on Treatment of Hepatitis C 2015”. Journal of Hepatology 2015 vol. 63j 199–236
6. Fabrizi F, Martin P, Dixit V, Bunnapradist S, and Dulai G (2005). “Hepatitis C virus antibody status and survival after renal transplantation: meta-analysis of observational studies”. American Journal of Transplantation, vol. 5(6), pp. 1452–1461
7. J.Levitsky, K.Doucette (2013). Viral Hepatitis in solid organ transplantation. American Journal of Transplantation, vol 13, pp 147-168
8. Jordan J. Felt, Hamant Shah, 2016. “Management of hepatitis C infection”. Inpractice. Provided by Clinical Care Options, LLC, and Boston University
9. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. 2012. Volume 2, Issue 4, August 2012.
10. Marco Carbone,Paul Cockwelland James Neuberger.(2011). “Hepatitis C and Kidney Transplantation”. Review Article, International Journal of Nephrology.Volume 2011, Article ID 593291, 17pages, doi:10.4061/2011 /593291
11. Mark S. Sulkowski . (2016) . “Hepatitis C Management in Special Populations”
12. Massimo Colombo, Alessio Aghemo, Hong Liu, Jie Zhang et al .2017.”Treatment With Ledipasvir–Sofosbuvir for 12 or 24 Weeks in Kidney Transplant Recipients With Chronic Hepatitis C Virus Genotype 1 or 4 Infection: A Randomized Trial”. Ann Intern Med. 2017;166(2):109-117.
13. Nezam Afdhal, Stefan Zeuzem,Paul Kwo, Mario Chojkier, Norman Gitlin, Massimo Puoti, Manuel Romero-Gomez, Jean-Pierre Zarski, Kosh Agarwal, Peter Buggisch, Graham R. Foster, et all (2014). “Ledipasvir and Sofosbuvir for Untreated HCV Genotype 1 infection”. The New England Journal of Medicine, May 2014,370, (20), pp 1889-1898.
14. Scott DR, Wong JK, Spicer TS, et al (2010). “Adverse impact of hepatitis C virus infection on renal replacement therapy and renal transplant patients in Australia and New Zealand”. Transplantation;vol. 90(11), pp. 1165–1171.
15. World Health Organisation, (2018). Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C infection. Guideline, July 2018”.world Health Organization. Prited in France
16. World Health Organisation. 2016. “Guidelines for the screening care and treatment of persons with chronic hepatitis C infection. Updated version, April 2016.
17. World Health Organization. 2016. “Guidelines for the screening care and treatment of persons with chronic hepatitis C infection”.