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.