Fibrosing Cholestatic Hepatitis in HIV/HCV Co-Infected Transplant Patients—Usefulness of Early Markers After Liver Transplantation

Authors

  • T. M. Antonini,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
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  • M. Sebagh,

    1. Univ. Paris-Sud, UMR-S 785
    2. Inserm, Unité 785, Villejuif F-94800, France
    3. AP-HP Hôpital Paul Brousse, Service Anatomie Pathologique
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  • A. M. Roque-Afonso,

    1. Univ. Paris-Sud, UMR-S 785
    2. Inserm, Unité 785, Villejuif F-94800, France
    3. AP-HP Hôpital Paul Brousse, Service Microbiologie
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  • E. Teicher,

    1. AP-HP Hôpital Paul Brousse, Service Infectiologie, Villejuif F-94800, France
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  • B. Roche,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
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  • R. Sobesky,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
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  • A. Coilly,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
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  • P. Vaghefi,

    1. Univ. Paris-Sud, UMR-S 785
    2. Inserm, Unité 785, Villejuif F-94800, France
    3. AP-HP Hôpital Paul Brousse, Service Microbiologie
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  • R. Adam,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
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  • D. Vittecoq,

    1. Univ. Paris-Sud, UMR-S 785
    2. Inserm, Unité 785, Villejuif F-94800, France
    3. AP-HP Hôpital Paul Brousse, Service Microbiologie
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  • D. Castaing,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
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  • D. Samuel,

    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
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  • J.-C. Duclos-Vallée

    Corresponding author
    1. AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France
    2. Univ. Paris-Sud, UMR-S 785
    3. Inserm, Unité 785, Villejuif F-94800, France
      Jean-Charles Duclos-Vallee, jean-charles.duclos-vallee@pbr.aphp.fr
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Jean-Charles Duclos-Vallee, jean-charles.duclos-vallee@pbr.aphp.fr

Abstract

We characterized fibrosing cholestatic hepatitis (FCH) in a large cohort of HIV/HCV co-infected patients. Between 1999 and 2008, 59 HIV infected patients were transplanted for end-stage liver disease due to HCV. Eleven patients (19%) developed FCH within a mean period of 7 months [2–27] after liver transplantation (LT). At Week 1 post-LT, the mean HCV viral load was higher in the FCH group: 6.13 log10 IU/mL ± 1.30 versus 4.9 log10 IU/mL ± 1.78 in the non-FCH group, p = 0.05. At the onset of acute hepatitis after LT, activity was moderate to severe in 8/11 HIV+/HCV+ patients with FCH (73%) versus 13/28 (46%) HIV+/HCV+ non-FCH (p = 0.007) patients. A complete virological response to anti-HCV therapy was observed in 2/11 (18%) patients. Survival differed significantly between the two groups (at 3 years, 67% in non-FCH patients versus 15% in FCH patients, p = 0.004). An early diagnosis of FCH may be suggested by the presence of marked disease activity when acute hepatitis is diagnosed and when a high viral load is present. The initiation of anti-HCV therapy should be considered at this point.

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