Reactivation of Herpesvirus in Patients With Hepatitis C Treated With Direct-Acting Antiviral Agents

• Published in: Clinical gastroenterology and hepatology Vol. 14; no. 11; pp. 1662 - 1666.e1
• Main Authors: Perelló M., Christie, Fernández-Carrillo, Carlos, Londoño, María-Carlota, Arias-Loste, Teresa, Hernández-Conde, Marta, Llerena, Susana, Crespo, Javier, Forns, Xavier, Calleja, José Luis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016
• Subjects: Aged; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Antiviral Immune Response; Cohort Studies; Gastroenterology and Hepatology; Hepatitis C Virus; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Herpesviridae - drug effects; Herpesviridae - physiology; Humans; Keratitis, Herpetic - chemically induced; Middle Aged; Neuralgia, Postherpetic - chemically induced; Spain; Varicella-Zoster Virus; Viral Reactivation; Virus Activation - drug effects; Varicella-Zoster Virus; hepatitis B virus; LT; HV; SVR; HZ; VZV; herpesvirus; PHN; PEG-IFN; Viral Reactivation; sustained virologic response; HBV; hepatocellular carcinoma; pegylated-interferon; Hepatitis C Virus; Antiviral Immune Response; herpes zoster; ribavirin; DAA; RBV; HCC; immune reconstitution inflammatory syndrome; direct-acting antivirals; IRIS; postherpetic neuralgia; HCV; liver transplantation
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2016.05.016

We performed a case-series analysis of reactivation of herpesvirus in patients with hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents. We collected data from 576 patients with HCV infection treated with DAA combinations at 3 hospitals in Spain, from November 2014 through November 2015. We also collected data from a control population (230 HCV-infected patients, matched for sex and age; 23 untreated and 213 treated with interferon-based regimens). Herpesvirus was reactivated in 10 patients who received DAA therapy (7 patients had cirrhosis and 3 patients had received liver transplants), a median of 8 weeks after the therapy was initiated. None of the controls had herpesvirus reactivation. Patients with herpesvirus reactivation were receiving the DAA agents sofosbuvir with ledipasvir (with or without ribavirin, 7/10), ombitasvir with paritaprevir and ritonavir plus dasabuvir (with or without ribavirin, 2/10), or sofosbuvir with simeprevir plus ribavirin (1/10). Two of the 10 patients developed postherpetic neuralgia and 1 patient developed kerato-uveitis. All 10 patients with herpesvirus reactivation achieved a sustained virologic response. Immune changes that follow clearance of HCV might lead to reactivation of other viruses, such as herpesvirus. Patients with HCV infection suspected of having herpesvirus infection should be treated immediately. Some groups also might be screened for herpesvirus infection.