recurrent hcv treatment

[Bill200]

With recurrent hcv, sometimes you retreat with interferon?  Do you add ribavirin too?

What are the considerations when deciding to retreat with inf vs. lowering immune-suppressents?

Is there any point to retreating if the patient is a previous non-responder?

[Thomas D Schiano, MD]

it contains immune cells within it

[Bill200]

Is the liver considered part of the immune system as well?

[Thomas D Schiano, MD]

no, IL28B is present whether HCV is present or not

[Bill200]

Interesting.  But isn't the genotype based on the hcv?  If the donor doesn't have that shouldn't the genotype remain the same as before?

[Thomas D Schiano, MD]

small studies have shown that previous response might not be as important as we think--remember that the donor liver brings into play another immune system and IL28B genotype

[Bill200]

What is the rationale for saying previous response should not impact the decision to retreat?  If a patient has not responded one or more times to the SOC, what is the point in retreating?  Wouldn't the side effects far outweigh any marginal benefit or is there a reason it might work when it did not previously?

[Thomas D Schiano, MD]

previous response to interferon should not impact on the decision to treat post-liver transplantation.  adequate immunosuppression should be maintained during treatment.  usually treatment would be considered if the patient has stage 2 fibrosis or more on liver biopsy. both intereferon and ribavirin should be used.