Intrahepatic antiviral quantification in a patient undergoing orthotopic cadaveric liver transplantation

Sir, Patients with end-stage liver disease (ESLD) have lower rates of sustained virological response to hepatitis C virus (HCV) treatment compared with those without significant hepatic impairment.1 There may be pathophysiological alterations associated with ESLD, which may alter drug penetration or drug activation in the liver.2 Comparing the concentrations of antiviral drugs in liver versus blood may inform drug selection in ESLD. The objective of this work was to quantify antiviral drugs in liver tissue and the active, phosphorylated forms of nucleos(t)ide analogues (NAs) in hepatocytes obtained from a fresh liver explant and to compare these values with drug concentrations in paired plasma and PBMCs. A 50-year-old male with HIV/HCV coinfection on the liver transplant list was transferred to our hospital with acute kidney injury (serum creatinine 4.11 mg/dL) with a Model for ESLD score of 40. In the year prior to hospitalization, the patient's antiretroviral regimen included 300 mg of tenofovir disoproxil fumarate once daily plus 200 mg of emtricitabine once daily, 800 mg of darunavir once daily, 100 mg of ritonavir once daily and 400 mg of raltegravir twice daily. The patient had an HIV-1 RNA of