Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Non-Organ Specific: Viral Hepatitis
Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
Location: Room 309
*Purpose: End-stage renal disease (ESRD) patients co-infected with HCV and HIV have access to effective treatment options for HCV infection. However, they also have access to HCV-infected kidneys, which historically afford shorter times to transplantation. Given high waitlist mortality and rapid progression of liver fibrosis among co-infected kidney-only transplant candidates identifying the optimal treatment strategy is paramount.
*Methods: Two strategies, treatment pre- and post-transplant, were compared using Monte Carlo microsimulation of 1,000,000 candidates. The microsimulation was stratified by liver fibrosis stage at waitlist addition and wait-time over a lifetime time horizon.
*Results: Treatment post-transplant was consistently cost-saving as compared to treatment pre-transplant due to the high cost of dialysis. Among patients with low fibrosis disease (F0-F1), treatment post-transplant also yielded higher life months (LM) and quality-adjusted life months (QALM) except among F1 candidates with wait-times >18 months. For candidates with advanced liver disease (F2-F4), treatment pre-transplant afforded more LM and QALM unless wait-time was < 18 months. Moreover, treatment pre-transplant was cost-effective for F2 candidates with wait-times > 71 months and F3 candidates with wait-times > 18 months.
*Conclusions: Thus, optimal timing of HCV treatment differs based on liver disease severity and wait-time, favoring pre-transplant treatment when cirrhosis development prior to transplant seems likely.
To cite this abstract in AMA style:Shelton B, Berdahl G, Sawinski D, Linas B, Reese P, Mustian M, Reed R, MacLennan P, Locke J. Optimal Timing of Hepatitis C Treatment among HIV/HCV Co-Infected End-Stage Renal Disease Patients: Pre vs. Post-Transplant [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/optimal-timing-of-hepatitis-c-treatment-among-hiv-hcv-co-infected-end-stage-renal-disease-patients-pre-vs-post-transplant/. Accessed September 22, 2019.
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