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

Area of Science:

• Nephrology
• Hepatology
• Infectious Diseases

Background:

• Chronic hepatitis C virus (HCV) infection frequently affects patients with chronic kidney disease (CKD), including those on hemodialysis.
• While many HCV-infected patients with end-stage renal disease are asymptomatic, some may develop advanced liver conditions like decompensated liver disease and hepatocellular carcinoma.

Purpose of the Study:

• To review current treatment options for HCV infection in patients with varying stages of CKD.
• To highlight the efficacy and contraindications of specific direct-acting antiviral (DAA) regimens.
• To emphasize the importance of interferon-free therapies for HCV eradication in renally impaired populations.

Main Methods:

• Review of current literature on HCV treatment in CKD patients.
• Analysis of efficacy and safety data for elbasvir/grazoprevir and glecaprevir/pibrentasvir regimens.
• Evaluation of sofosbuvir-based regimens and interferon-based therapies in renally impaired patients.

Main Results:

• Elbasvir/grazoprevir (12 weeks) and glecaprevir/pibrentasvir (8-16 weeks) achieve high sustained virologic response (SVR) rates in patients with HCV genotypes 1, 1a, 1b, 4, and stages 4-5 CKD.
• These DAA regimens are contraindicated in advanced decompensated cirrhosis.
• Sofosbuvir-based regimens may be suitable for mild renal impairment, while generally not recommended for severe impairment.

Conclusions:

• Interferon-free direct-acting antiviral therapies are highly effective for treating HCV in patients with CKD.
• Treatment decisions must consider the stage of renal impairment and the presence of cirrhosis.
• Worldwide HCV elimination necessitates treating all HCV-infected patients with renal impairment using interferon-free regimens.