Key result
Sofosbuvir added to ribavirin fails to achieve sustained viral clearance in chronic hepatitis E.
Why the study?
No established treatments exist for organ transplant recipients who fail to clear chronic hepatitis E following immunosuppression reduction or ribavirin, and the in vivo clinical utility of sofosbuvir is unknown.
Does sofosbuvir added to ribavirin improve viral clearance in a liver transplant recipient with chronic hepatitis E?
Case Report (n=1)
No
Does sofosbuvir added to ribavirin improve viral clearance in a liver transplant recipient with chronic hepatitis E?
Sofosbuvir added to ribavirin may have transient antiviral activity against HEV in liver transplant recipients, but failed to achieve sustained viral clearance in this case.
May support sofosbuvir trial in ribavirin-refractory post-transplant HEV; leaves open need for controlled efficacy data.
BACKGROUND: Chronic hepatitis E represents an emerging challenge in organ transplantation, as there are currently no established treatment options for patients who fail to clear hepatitis E virus (HEV) following reduction of immunosuppressive therapy and/or treatment with ribavirin. Sofosbuvir has shown antiviral activity against HEV in vitro but clinical utility in vivo is unknown. CASE PRESENTATION: We describe a 57-year-old liver transplant recipient with decompensated graft cirrhosis due to chronic hepatitis E. Reduction of immunosuppressive treatment as well ribavirin alone for 4 months did not result in viral clearance. Add-on of sofosbuvir for 6 months was associated with HEV RNA becoming undetectable in plasma. However, sustained viral clearance could not be achieved. CONCLUSIONS: Sofosbuvir may have some antiviral activity against HEV when added to ribavirin. However, this did not suffice to yield sustained viral clearance. Our well-characterized observation emphasizes the need for new treatment options to cure chronic hepatitis E in the setting of organ transplantation.
No takes yet. Share an insight, caveat, or question.
Fraga et al. (2019) conducted a case report in Chronic hepatitis E (n=1). Sofosbuvir vs. Ribavirin monotherapy was evaluated on Sustained viral clearance. Sofosbuvir added to ribavirin resulted in transient undetectable HEV RNA in plasma but failed to achieve sustained viral clearance in a liver transplant recipient with chronic hepatitis E.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: