Published in:
Open Access
01-03-2019 | Guidelines
APASL clinical practice recommendation: how to treat HCV-infected patients with renal impairment?
Authors:
Tatsuo Kanda, George K. K. Lau, Lai Wei, Mitsuhiko Moriyama, Ming-Lung Yu, Wang-Long Chuang, Alaaeldin Ibrahim, Cosmas Rinaldi Adithya Lesmana, Jose Sollano, Manoj Kumar, Ankur Jindal, Barjesh Chander Sharma, Saeed S. Hamid, A. Kadir Dokmeci, Mamun-Al-Mahtab, Geofferey W. McCaughan, Jafri Wasim, Darrell H. G. Crawford, Jia-Horng Kao, Osamu Yokosuka, Shiv Kumar Sarin, Masao Omata
Published in:
Hepatology International
|
Issue 2/2019
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Abstract
Chronic hepatitis C virus (HCV) infection is common among patients with chronic kidney disease (CKD) and those on hemodialysis due to nosocomial infections and past blood transfusions. While a majority of HCV-infected patients with end-stage renal disease are asymptomatic, some may ultimately experience decompensated liver diseases and hepatocellular carcinoma. Administration of a combination of elbasvir/grazoprevir for 12 weeks leads to high sustained virologic response (SVR) rates in patients with HCV genotypes (GTs) 1a, 1b or 4 and stage 4 or 5 CKD. Furthermore, a combination of glecaprevir/pibrentasvir for 8–16 weeks also results in high SVR rates in patients with all HCV GTs and stage 4 or 5 CKD. However, these regimens are contraindicated in the presence of advanced decompensated cirrhosis. Although sofosbuvir and/or ribavirin are not generally recommended for HCV-infected patients with severe renal impairment, sofosbuvir-based regimens may be appropriate for those with mild renal impairment. To eliminate HCV worldwide, HCV-infected patients with renal impairment should be treated with interferon-free therapies.