• Can Direct-acting Antivirals Treatment of HCV Reactivate Herpesvirus Infection?

Can Direct-acting Antivirals Treatment of HCV Reactivate Herpesvirus Infection?

Researchers report reactivation of herpesvirus in 10 patients with hepatitis C virus (HCV) infection treated with direct-acting antiviral (DAA) agents in the November issue of Clincial Gastroenterology and Hepatology.

Severe herpes zoster in a liver transplant recipient, who developed herpes zoster along 1left thoracic metamere at treatment week 20 of DAA treatment.

Severe herpes zoster in a liver transplant recipient, who developed herpes zoster along the left thoracic metamere at week 20 of DAA treatment. Dermatologic manifestations were accompanied by severe pain, which turned into post-herpetic neuralgia requiring neural ablation.

Christie Perelló et al performed a case series analysis of reactivation of herpesvirus in patients with HCV infection treated with DAA agents. They collected data from 576 patients with HCV infection treated with DAA combinations at 3 hospitals in Spain, and 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).

They found herpesvirus to be 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.

Ten of the patients with herpesvirus reactivation were receiving the DAA agents sofosbuvir with ledipasvir. Two were receiving ombitasvir with paritaprevir and 2 were receiving ritonavir plus dasabuvir. One patient was receiving sofosbuvir with simeprevir plus ribavirin.

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.

All of the herpesvirus reactivations occurred during the HCV treatment. Seven of the patients were immunocompetent, but had a reduced lymphocyte count. Perelló et al propose that immune changes that follow clearance of HCV might lead to reactivation of other viruses, such as herpesvirus.

The herpesvirus family is known for its ability to establish life-long infection. Most adults are infected with herpes virus-1, varicella-zoster virus (VZV), Epstein–Barr virus, and probably herpes virus-6 and herpes virus-7. The balance between latency and reactivation seems to be a complex process about which little is understood.

The authors conclude that patients with HCV infection suspected of having herpesvirus infection should be treated immediately. Some groups also might be screened for herpesvirus infection.

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