Ribavirin for chronic hepatitis E virus infection in transplant recipients
New England Journal of Medicine,  Evidence Based Medicine  Clinical Article

Kamar N, et al. – 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. 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.

Methods

  • Authors 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%.

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Internal Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Internal Medicine Articles

1 Effects of tea intake on blood pressure: A meta-analysis of 21 randomized controlled trials JACC - Journal of the American College of Cardiology, October 22, 2014    Clinical Article

2 Sweetened carbonated beverage consumption and cancer risk: Meta-analysis and review European Journal of Cancer Prevention, August 1, 2014    Evidence Based Medicine    Review Article

3 Acupuncture for chronic knee pain: a randomized clinical trial JAMA, October 1, 2014    Evidence Based Medicine    Clinical Article

4 Evaluation and treatment of older patients with hypercholesterolemia: A clinical review JAMA, October 20, 2014    Clinical Article

5 Lower versus higher hemoglobin threshold for transfusion in septic shock New England Journal of Medicine, October 7, 2014    Evidence Based Medicine    Clinical Article

6 Association between circulating 25-hydroxyvitamin D and incident type 2 diabetes: A mendelian randomisation study The Lancet Diabetes & Endocrinology, October 21, 2014    Clinical Article

7 Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review Annals of Internal Medicine, September 29, 2014    Evidence Based Medicine    Review Article    Clinical Article

8 Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial The Lancet, October 16, 2014    Evidence Based Medicine    Clinical Article
Exclusive Author Commentary

9 Total expenditures per patient in hospital-owned and physician-owned physician organizations in California JAMA, October 24, 2014    Evidence Based Medicine    Clinical Article

10 Triglycerides and cardiovascular disease The Lancet, August 19, 2014    Evidence Based Medicine    Clinical Article

11 Nut consumption and the risk of coronary artery disease: A dose–response meta-analysis of 13 prospective studies Thrombosis Research, October 22, 2014    Clinical Article

12 Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak The Lancet, October 23, 2014    Evidence Based Medicine    Clinical Article

13 Association of fat density with subclinical atherosclerosis Full Text Journal of the American Heart Association, September 19, 2014    Free full text

14 A randomized trial of epidural glucocorticoid injections for spinal stenosis New England Journal of Medicine, July 7, 2014    Evidence Based Medicine    Clinical Article

15 Ivabradine in stable coronary artery disease without clinical heart failure New England Journal of Medicine, September 2, 2014    Evidence Based Medicine    Clinical Article

16 Livebirth after uterus transplantation The Lancet, October 9, 2014    Evidence Based Medicine    Clinical Article

17 Exercises to improve function of the rheumatoid hand (SARAH): a randomised controlled trial The Lancet, October 14, 2014    Evidence Based Medicine    Clinical Article

18 Plasma triglycerides predict ten-years all-cause mortality in outpatients with type 2 diabetes mellitus: a longitudinal observational study Full Text Cardiovascular Diabetology, October 17, 2014    Free full text    Clinical Article

19 Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study Full Text PLoS Medicine, October 3, 2014    Free full text    Evidence Based Medicine    Clinical Article

20 The influence of whole grain products and red meat on intestinal microbiota composition in normal weight adults: A randomized crossover intervention trial PLOS ONE, October 22, 2014    Clinical Article

Indexed Journals in Internal Medicine: New England Journal of Medicine, The Lancet, Archives of Internal Medicinemore