Efficacy and Safety of Sofosbuvir-Based Regimens in Patients with Viral Hepatitis C and Stage 4 and 5 Chronic Kidney Disease: The Cameroon Experience

Abstract

Background and objectives:Treatment of viral hepatitis C in chronic kidney disease patients with glomerular filtration rate < 30 ml/min/1.73 m 2 remains a challenge in countries with combinations containing only sofosbuvir. We investigated the efficacy and safety of sofosbuvir based regimens in patients infected with hepatitis C virus and stage 4 and 5 chronic kidney disease. Methods:We conducted a multicentric, retrospective study of patients records treated for viral hepatitis C and chronic kidney disease. We collected data on adverse events, renal function during and after treatment, and virological response during and after treatment. Results:We recruited 28 patients, including 13 patients on maintenance haemodialysis and 17 men. The mean age was 60.68 ± 13.00 years. Cirrhosis was found in 12 (43%) patients. The genotypes found were 1, 2 and 4. There were 27 (96.4%) treatment-naïve patients. The different combinations found were: Sofosbuvir 400 mg twice a week + ribavirin 200 mg daily (3.6%, n = 1), sofosbuvir 400 mg + daclatasvir 60 mg daily (21.6%, n = 6), sofosbuvir 400 mg + ledipasvir 90 mg daily in two patients, twice a week in 9 patients and three times a week in one patient (43.2%, n = 12), sofosbuvir 400 mg + velpatasvir 100 mg daily in 6 patients, twice weekly in three patients (32.4%, n = 9). The sustained virological response rate was 100% in the 21 patients who did viral load after treatment. The main adverse events were nausea (10.7%), vomiting (10.7%), dizziness (7.1%), headache (7.1%) and pruritus (7.1%). The glomerular filtration rate was 22.3 ± 5.7 ml/min/1.73 m 2 at the start of treatment, 17.7 ± 4 ml/min/1.73 m 2 at the end of treatment and 20.7 ± 5.3 ml/min/1.73 m 2 three months after treatment. Conclusion:Treatment with sofosbuvir-containing regimens is effective and well tolerated in patients infected with hepatitis C virus and stage 4 and 5 chronic kidney disease.