Treatment of Hepatitis C Virus Infection in Dialysis Patients

Since 2014, all-oral, interferon (IFN)-free, direct-acting antiviral (DAA) regimens including daclatasvir + asunaprevir dual regimen, ledipasvir/sofosbuvir combination, ombitasvir/paritaprevir/ritonavir combination, elbasvir + grazoprevir dual regimen, and glecaprevir/pibrentasvir combination have been approved for the treatment of hepatitis C. Studies on DAA regimens reported that DAA therapy causes far fewer adverse reactions compared with IFN therapy and exhibits high efficacy in treating hepatitis C virus (HCV) infection in hemodialysis patients, although the ledipasvir/sofosbuvir combination cannot be used for dialysis patients because sofosbuvir is contraindicated for patients with estimated glomerular filtration rate of <30 mL/min/1.73 m2. Since the safety of DAA therapy in elderly patients has also been confirmed, there is basically no age limit for the use of DAAs. The time has come for any hemodialysis patient to receive effective treatment for curing HCV infection.

The prevalence of HCV infection among dialysis patients in Japan was as high as 6.2% as of 2015. However, numerous patients are left untreated because of the limited efficacy of and adverse reactions caused by IFN.

In Japan, the approval of an all-oral, IFN-free, DAA regimen in 2014 marked a paradigm shift for the treatment of HCV infection in patients with dialysis. DAA therapy causes far fewer adverse reactions compared with IFN therapy and has been reported to be highly effective in treating HCV infection in hemodialysis patients. Key Messages: A remarkable progress in HCV treatment has allowed all patients with chronic hepatitis C to receive effective therapies to cure the disease.