Thank you for offering answer sessions. Data from the last retroviral conference and others show that we need better treatment for HCV. What are treatment options for HCV positive subjects in particular postliver transplant? How good is RBV and PEG-INF and what to do if they failed already? Which nonapproved drugs would you use (heptazyme phase one?). Why is Ig effective in HBV but not HCV. What is your approach for HCV/HIV transplant recipients, who failed multiple HCV specific therapies to prolong survival? thank you
 

Tough questions, but PEGIFN and RBV have had rather disappointing results in the postOLT setting, not surprisingly. however, these agents even if they do not bring about virologic remission, can still potentially improve allograft histology. We are now exploring prophylactic use of these meds postOLT for this reason. As for other agents, i am not sure about heptazyme at this juncture, but there would be particular hope for the enzymatic (protease, helicase, polymerase inhibitors) HBIg works because it is neutralizing Ab, the HCV Igs are not. We have not transplanted coinfected persons, but these pts have had a difficult time with recurrent HCV disease. I believe that low-dose steroids and trying to lower the setpoint of virus is important, but so too is viral suppression, so for now we liberally use PEGIFN + RBV based regimens to try to halt disease progression.