In 2019, to help meet viral hepatitis targets from the WHO, studies have developed optimal strategies to enable transplantation of HCV-positive organs, assessed the real-world efficacy of salvage therapy for direct-acting antiviral therapy failures in chronic HCV infection and evaluated the risk of hepatocellular carcinoma with current first-line antiviral therapies for chronic HBV infection.
Key advances
The safety and efficacy of transplanting HCV-positive donor organs into uninfected recipients using pre-emptive direct-acting antiviral (DAA) therapy was demonstrated1,2.
The real-world efficacy of salvage therapy with sofosbuvir, velpatasvir and voxilaprevir was shown in patients with chronic HCV infection who have previously failed DAA therapy4,5.
Provocative data from a meta-analysis suggest reduced hepatocellular carcinoma risk in patients receiving tenofovir compared with entecavir for chronic HBV infection7 but there have been conflicting reports since.
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References
Woolley, A. E. et al. Heart and lung transplants from HCV-infected donors to uninfected recipients. N. Engl. J. Med. 380, 1606–1617 (2019).
Bethea, E. D. et al. Pre-emptive pangenotypic direct acting antiviral therapy in donor HCV-positive to recipient HCV-negative heart transplantation: an open-label study. Lancet Gastroenterol. Hepatol. 4, 771–780 (2019).
Bourliere, M. et al. sofosbuvir, velpatasvir, and voxilaprevir for previously treated HCV infection. N. Engl. J. Med. 376, 2134–2146 (2017).
Belperio, P. S., Shahoumian, T. A., Loomis, T. P. & Backus, L. I. Real-world effectiveness of sofosbuvir/velpatasvir/voxilaprevir in 573 direct-acting antiviral experienced hepatitis C patients. J. Viral. Hepat. 26, 980–990 (2019).
Sarrazin, C. et al. No impact of resistance-associated substitutions on the efficacy of sofosbuvir, velpatasvir, and voxilaprevir for 12 weeks in HCV DAA-experienced patients. J. Hepatol. 69, 1221–1230 (2018).
Forner, A., Reig, M. & Bruix, J. Hepatocellular carcinoma. Lancet 391, 1301–1314 (2018).
Zhang, Z. et al. The effectiveness of TDF versus ETV on incidence of HCC in CHB patients: a meta analysis. BMC Cancer 19, 511 (2019).
Choi, J. et al. Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis b: a Korean nationwide cohort study. JAMA Oncol. 5, 30–36 (2019).
Yip, T. C. et al. Tenofovir is associated with lower risk of hepatocellular carcinoma than entecavir in patients with chronic HBV infection in China. Gastroenterology 158, 215–225.e6 (2019).
Kim, S. U. et al. A multicenter study of entecavir vs. tenofovir on prognosis of treatment-naive chronic hepatitis B in South Korea. J. Hepatol. 71, 456–464 (2019).
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Holmes, J.A., Chung, R.T. New approaches in viraemic organ transplantation and antiviral therapies. Nat Rev Gastroenterol Hepatol 17, 78–79 (2020). https://doi.org/10.1038/s41575-019-0257-0
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DOI: https://doi.org/10.1038/s41575-019-0257-0
