Should all dialysis patients with hepatitis C be treated? If so, before or after kidney transplantation?

Area of Science:

• Hepatology
• Nephrology
• Infectious Diseases

Background:

• Hepatitis C virus (HCV) infection poses significant risks for patients with chronic kidney disease (CKD), particularly those on dialysis.
• Recent advancements offer highly effective, interferon-free treatments for HCV genotypes 1 and 4.

Discussion:

• New 12-week antiviral regimens achieve near 100% cure rates in stage 4-5 CKD patients, including those on dialysis.
• Treatment decisions for HCV in CKD require careful consideration of individual patient factors.
• The optimal timing for initiating HCV antiviral therapy is crucial and depends on several clinical parameters.

Key Insights:

• HCV is now curable in nearly all advanced CKD patients, including dialysis patients, with modern antiviral therapies.
• Interferon-free direct-acting antiviral regimens are effective and well-tolerated, administered over a short 12-week duration.
• Patient management requires a personalized approach, balancing transplant potential, liver fibrosis, and portal hypertension.

Outlook:

• HCV treatment in CKD is expected to become even more streamlined with the upcoming licensing of newer pangenotypic regimens.
• Future strategies may allow for easier treatment of genotypes 2, 3, 5, and 6 after kidney function restoration.
• The high cure rates underscore the importance of treating HCV in CKD patients unless life expectancy is very limited.