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- W2914886005 abstract "We present the case of a post-transplant patient with HCV GT1A with extensive failed treatment history. This patient represents a unique population with drug resistance, reduced therapeutic response and adverse outcomes associated with treatment failure. A 31 year old male with HCV acquired via vertical transmission, underwent cadaveric liver transplant for HCV associated decompensated cirrhosis. While on cellcept/tacrolimus immunosuppression, one month post-transplant viral load was >100,000,000 IU/mL and biopsy demonstrated high viral activity. Previous HCV targeted therapies were 1) peginterferon /ribavirin with non-response 2)Peginterferon/ribavirin and telapravir with decompensation of hepatic function 3) Ledipasvir/sofosbuvir x 24 weeks with relapse, and 4) Simeprevir/sofosbuvir therapy also with relapse. Viral resistance testing showed NS5A but not NS3 resistance. This patient was treated post-transplant with elbasvir(50mg)/grazoprevir(100mg)/sofosbuvir (400mg) and ribavirin 600 milligrams x 12 weeks with slow response and undetectable viral load at 8 and 12 weeks of treatment and 4 weeks post treatment. He is still awaiting SVR12 labs. Patients with NS5A variants and previous DAA treatment failure are challenging to treat, and this is compounded by immunosuppressant medication in the post-transplant patient. If treatment cannot be deferred, treatment should be extended for 24 weeks and minimum of dual DAA therapy should be used, and triple or quadruple regimens considered. Elbasvir and grazoprevir are among the highly efficacious DAA treatment regimens with SVR12 as high as 98% in patients without NS5A polymorphisms. However, the existence polymorphisms of NS5A may reduce efficacy to as low as 70%. Efficacy may be improved by the extension of therapy or the addition of ribavirin, but with unclear standardization of treatment duration, and much is left to discretion of the physician and the mercy of the insurance coverage. Additionally, complex medication regimens in the post-transplant patient including immunosuppressive therapies may have serious interactions and impact on drug levels and require careful monitoring throughout the treatment course. Elbasvir and grazoprevir are not among the recommended post-transplant regimens based on current guidelines due to unclear impact on immunosuppressive therapy drug levels, but this regimen was well tolerated with initial response in our patient. We eagerly await his next laboratory results." @default.
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- W2914886005 date "2017-10-01" @default.
- W2914886005 modified "2023-09-25" @default.
- W2914886005 title "Finding a Way: Hepatitis C Virus Recurrence in a Post-Liver Transplant Patient With Multiple Treatment Failures" @default.
- W2914886005 doi "https://doi.org/10.14309/00000434-201710001-02354" @default.
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