Effect of Sofosbuvir-Based Hepatitis C Virus Therapy on Kidney Function in Patients with CKD

Hepatitis C virus infection (HCV) is highly prevalent in patients with chronic kidney disease (CKD) and kidney transplant recipients. Little information exists on treatment in patients with CKD stages 2 to 3, where CKD progression might be slowed by HCV treatment. These patients are not considered a high priority for HCV treatment in most international guidelines. Although some recently published guidelines propose universal treatment, others are still recommending it only in high priority groups. In this review, we evaluate current evidence of HCV infection impact on CKD progression, on cardiovascular and metabolic risk, and the benefits of HCV infection treatment to improve cardiovascular and metabolic outcomes. We made special focus on the benefits of HCV infection treatment in patients with stages 2 to 3 CKD to avoid CKD progression.

Section: Current Regimens Available For Patients Ckdmentioning

confidence: 95%

Section: Current Regimens Available For Patients Ckdmentioning

confidence: 99%

Section: Current Regimens Available For Patients Ckdmentioning

confidence: 99%

See 1 more Smart Citation

Rationale for treating hepatitis C virus infection in patients with mild to moderate chronic kidney disease

Ridruejo

Mendizábal

Silva

2018

“…Among patients chronically infected with HCV, DAA therapy was associated with a 30% lower risk of new‐onset CKD (hazard ratio 0.70, 95% CI 0.55–0.88) . Among those with chronic HCV infection and advanced CKD (eGFR <60 mL/min per 1.73 m 2 ), achievement of SVR following DAA therapy was associated with a 9.3 mL/min per 1.73 m 2 (95% CI 0.44–18) improvement in eGFR …”

Section: Treatmentmentioning

confidence: 99%

Hepatitis C virus infection in patients with end‐stage renal disease

Wigneswaran¹,

Wyck

Pegues

et al. 2018

Chronic hepatitis C virus (HCV) infection is a major global health problem affecting 3-5 million people in the United States and over 100 million worldwide. Chronic HCV infection, which can lead to cirrhosis and hepatocellular carcinoma, also results in numerous other complications, including impairment of renal function. Because HCV is most often transmitted via parenteral exposure to blood or blood products, patients with end-stage renal disease (ESRD) treated with hemodialysis are at particular risk for infection. Historically, the medications available to treat HCV infection in these patients had significant side effects and were not particularly effective in generating a sustained virologic response. Since 2011, a number of direct-acting antiviral therapies have emerged that can lead to virological cure in the vast majority of patients, with low pill burden and few side effects. Here, we describe the biology and pathophysiology of HCV infection, and summarize current information on new therapies, with a particular focus on their application in patients with chronic kidney disease including ESRD.

“…Currently, increasing evidence support the safety and the efficacy of treatment of HCV in Chronic Kidney Disease4‐5 and ESRD patients and particularly in pre and posttransplant patients with minimal side‐effects . Virtually, all patients with HCV can be treated with DAAs.…”

Section: Direct‐acting Antiviral Agents: the Here And Now Of Hcv Therapymentioning

confidence: 99%

Hepatitis C virus infection in kidney transplantation‐changing paradigms with novel agents

Reddy

Nunes

Chitalia

et al. 2018

Hepatitis C virus (HCV) is a common cause of increased morbidity and mortality in kidney transplant patients. It is associated with posttransplant glomerulonephritis, chronic allograft nephropathy, and New Onset Diabetes after Transplant (NODAT). In the past, HCV was difficult to treat due to the presence of interferon alpha-based therapies that were difficult to tolerate and were associated with adverse side-effects, such as the risk of rejection. With the advent of oral directly acting antiviral therapies, the landscape for HCV and transplantation has changed. These agents are highly effective and well tolerated with minimal side-effects. Sustained viral response rates in excess of 90% are achieved with most current treatment regimens active against all HCV genotypes. These new agents may show an improvement in graft and patient survival while essentially eliminating the risk of acute rejection from the use of prior interferon-based HCV therapies. These agents may also result in an improvement in organ allocation for HCV donor/HCV recipient transplantation. This review is meant to discuss the epidemiology of HCV, the new oral direct-acting antiviral agents (DAAs) and future opportunities for research in the field of HCV related transplantation.