Plasma hepatitis E virus kinetics in solid organ transplant patients receiving ribavirin

Sebastien Lhomme, Swati Debroy, Nassim Kamar, Florence Abravanel, David Metsu, Olivier Marion, Chloé Dimeglio, Scott Cotler, Jacques Izopet, Harel Dahari 


 July 2019

[Full TextPubmed]


Hepatitis E virus (HEV) infection causes chronic hepatitis in solid organ transplant (SOT) recipients. Antiviral therapy consists of 3 months of ribavirin, although response rates are not optimal. We characterized plasma HEV kinetic patterns in 41 SOT patients during ribavirin therapy. After a median pharmacological delay of 3 [range:0-21] days, plasma HEV declined from a median baseline level of 6.12 [3.53-7.45] log copies/ml in 4 viral kinetic patterns: (i) monophasic (n=18), (ii) biphasic (n=13), (iii) triphasic (n=8), and (iv) flat-partial response (n=2). The mean plasma HEV half-life was estimated to be 2.0±0.96 days. 25 (61%) had a sustained virological response (SVR) 24 weeks after completion of therapy. Viral kinetic patterns (i)-(iii) were not associated with baseline characteristics or outcome of therapy. A flat partial response was associated with treatment failure. All patients with a log concentration decrease of plasma HEV at day 7 of >15% from baseline achieved SVR. In conclusion, viral kinetic modeling of plasma HEV under ribavirin therapy showed, for the first time, four distinct kinetic profiles, a median pharmacologic delay of 3 days, and an estimated HEV half-life of 2 days. Viral kinetic patterns were not associated with response to therapy, with the exception of a flat partial response.