Hepatitis E virus (HEV) can induce chronic infections in the case of immunosuppression, which are sometimes not cured with ribavirin. Furthermore, sofosbuvir is a highly potent inhibitor of HCV polymerase and was shown to inhibit HEV genotype-3 replication in vitro. We report here the outcome of sofosbuvir/ribavirin therapy on a chronic HEV infection in a heart transplant recipient non-responder to ribavirin. After 24 weeks, the regimen failed to cure the persistent HEV infection, highlighting the need of therapeutic options for HEV-infected immunosuppressed patients.
References
1.
NeukamK., BarreiroP., MacíasJ.Chronic hepatitis E in HIV patients: rapid progression to cirrhosis and response to oral ribavirin.Clin Infect Dis2013; 57: 465–468.
2.
MansuyJ.M., GallianP., DimeglioC.A nationwide survey of hepatitis E viral infection in French blood donors.Hepatology2016; 63: 1145–1154.
3.
KamarN., RostaingL., AbravanelF.Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection.Gastroenterology2010; 139: 1612–1618.
4.
KamarN., IzopetJ., TriponS.Ribavirin for chronic hepatitis E virus infection in transplant recipients.N Engl J Med2014; 370: 1111–1120.
5.
Dao ThiV.L., DebingY., WuX.Sofosbuvir inhibits hepatitis E virus replication in vitro and results in an additive effect when combined with ribavirin.Gastroenterology2016; 150: 82–85.e4.
6.
MazzolaA., Tran MinhM., CharlotteF.Chronic hepatitis E viral infection after liver transplantation: a regression of fibrosis after antiviral therapy.Transplantation2017; 101: 2083–2087.
7.
TodescoE., DemeretS., CalinR.Chronic hepatitis E in HIV/HBV coinfected patient: lack of power of sofosbuvir-ribavirin.AIDS2017; 31: 1346–1348.
8.
DonnellyM.C., ImlachS.N., AbravanelF.Sofosbuvir and daclatasvir anti-viral therapy fails to clear HEV viremia and restore reactive T cells in a HEV/HCV co-infected liver transplant recipient.Gastroenterology2017; 152: 300–301.
9.
van der ValkM., ZaaijerH.L., KaterA.P., SchinkelJ.Sofosbuvir shows antiviral activity in a patient with chronic hepatitis E virus infection.J Hepatol2017; 66: 242–243.
10.
DebingY., GisaA., DallmeierK.A mutation in the hepatitis E virus RNA polymerase promotes its replication and associates with ribavirin treatment failure in organ transplant recipients.Gastroenterology2014; 147: 1008–1011.e7.
11.
NingQ., BrownD., ParodoJ.Ribavirin inhibits viral-induced macrophage production of TNF, IL-1, the procoagulant fgl2 prothrombinase and preserves Th1 cytokine production but inhibits Th2 cytokine response.J Immunol1998; 160: 3487–3493.
12.
TamR.C., PaiB., BardJ.Ribavirin polarizes human T cell responses towards a Type 1 cytokine profile.J Hepatol1999; 30: 376–382.
