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Jun 5, 2020

A 7-Day Antiviral Prophylaxis Regimen Prevents Donor-Derived HCV Transmission

By Nancy A. Melville

NEW YORK — June 5, 2020 — A 7-day prophylaxis regimen of direct acting antivirals (DAAs) is effective in preventing the transmission of donor-derived hepatitis C virus (HCV) infection, according to a study presented at the 2020 Virtual American Transplant Congress (ATC).

“Our data suggests that 7-day DAA prophylaxis is effective in preventing donor-derived HCV transmission and could result in significant cost-savings and increase access to these transplants all over the world,” said Gaurav Gupta, MD, Virginia Commonwealth University, Richmond, Virginia.

Dr. Gupta and colleagues previously showed that an ultra-short, 2- to 4-day perioperative prophylactic course of sofosbuvir/velpatasvir (Epclusa) prevented HCV transmission in 88% of recipients who were HCV-negative but had HCV-positive donors.

For the current study, 80 HCV-negative patients who received kidney transplants from HCV-positive donors were randomised to 1 of 3 groups. Group 1 received 1 dose of sofosbuvir/velpatasvir immediately before surgery followed by another dose 1 day post-transplant (n = 10); group 2 received the regimen of group 1 plus 2 additional doses of sofosbuvir/velpatasvir on days 2 and 3 post-transplant (n = 42); and group 3 received the regimen for 7 days (nv=v28).

With a median follow-up of 8 months, post-transplant survival was 99% and there were no cases of liver dysfunction or other HCV-associated complications.

The viral transmission rate in group 1 was 30%, 9.5% in group 2, and 3.5% — just 1 case — in group 3.

Among the 3 patients in group 1 who became infected with HCV, all had genotype 1 disease, and 1 patient did not respond to a subsequent full course of DAA therapy, possibly secondary to non-adherence. Of the patients in group 2, all were able to achieve sustained virologic response with subsequent DAA therapy.

“Although the ideal duration of prophylaxis remains to be determined, we suggest that prophylaxis may become the standard of care for HCV negative recipients of HCV-positive transplants,” said Dr. Gupta.

[Presentation title: Direct Acting Anti-Viral Prophylaxis to Prevent Virus Transmission From Hepatitis C Viremic Donors to Hepatitis C Negative Kidney Transplant Recipients. Abstract 004]