APASL clinical practice recommendation: how to treat HCV-infected patients with renal impairment?

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.Electronic supplementary materialThe online version of this article (10.1007/s12072-018-9915-5) contains supplementary material, which is available to authorized users.

Pre-existing minor variants with NS5A L31M/V-Y93H double substitution are closely linked to virologic failure with asunaprevir plus daclatasvir treatment for genotype 1b hepatitis C virus infection

“…In this study, we examined baseline RASs by deep sequencing of patients who started ASV/ DCV treatment. Although various regimens are available for GT1b hepatitis C virus infection, DCV and ASV combination therapy is still used and is one of the initial treatments for chronic hepatitis C or compensated cirrhosis patients with HCV genotype 1b infection in the Asian Pacific Association for the Study of the Liver (APASL) clinical practice recommendation [21] and the 2017 KASL Clinical Practice Guidelines for Management of Hepatitis C: Treatment of Chronic Hepatitis C [22]. Furthermore, testing for NS5A RASs is recommended prior to DCV and ASV combination therapy in these guidelines.…”

Glecaprevir–pibrentasvir for chronic hepatitis C: Comparing treatment effect in patients with and without end-stage renal disease in a real-world setting

“…The rate of premature treatment discontinuation was also analysed. ESRD was defined as chronic kidney disease stage 5 with dialysis [10] in the present study.…”

Evolutionary seroepidemiology of viral hepatitis and the gap in hepatitis C care cascades among uraemic patients receiving haemodialysis in Taiwan—the Formosa‐Like Group

“…14 Since 2014, the treatment of chronic hepatitis C (CHC) has entered the era of all-oral directly acting antivirals (DAAs), which have high treatment efficacy and safety even in CKD/uraemic patients. [15][16][17][18] Nevertheless, the treatment uptake of the anti-HCV regimen in this unique population may remain underappreciated. The updated treatment uptake of HCV in this population has yet to be determined.…”