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Indian Journal of Gastroenterology

, Volume 37, Issue 6, pp 492–503 | Cite as

Hepatitis C virus infection and chronic renal disease: A review

  • Amit Goel
  • Dharmendra Singh Bhadauria
  • Rakesh AggarwalEmail author
Review Article
  • 109 Downloads

Abstract

Hepatitis C virus (HCV) is a parenterally-transmitted hepatotropic virus that often causes chronic infection, which can progress to cirrhosis and hepatocellular carcinoma. Development of highly effective direct-acting anti-viral agents (DAAs) has led to a paradigm change in the treatment of HCV infection over the last 4–5 years. Patients with chronic kidney disease (CKD) are at a higher risk of acquiring HCV infection. In these patients, diagnosis of HCV infection, assessment of the consequent liver disease and management of HCV infection pose some specific problems. This article reviews the available recent information on HCV infection and CKD, including the association between these conditions and their effect on each other, and prevention, evaluation, and management of HCV infection in persons with CKD. This review looks at this issue particularly from the perspective of readers in Asia, especially India, since the epidemiology of HCV-CKD association and the repertoire of anti-HCV drugs available in this region differ from those elsewhere.

Keywords

Diagnosis End-stage renal disease Hemodialysis Hepatitis C virus Kidney Prevalence Prevention Transmission Treatment Viral hepatitis 

Notes

Compliance with ethical standards

Conflict of interest

AG, MSB, and RA declare that they have no conflict of interest.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

References

  1. 1.
    Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244:359–62.CrossRefGoogle Scholar
  2. 2.
    Kamal SM. Acute hepatitis C: a systematic review. Am J Gastroenterol. 2008;103:1283–97.CrossRefGoogle Scholar
  3. 3.
    KDIGO. KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2018;8:91–165.CrossRefGoogle Scholar
  4. 4.
    Levey AS, Coresh J, Greene T, et al. Chronic kidney disease epidemiology collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.CrossRefGoogle Scholar
  5. 5.
    Welzel TM, Petersen J, Herzer K, et al. Daclatasvir plus sofosbuvir, with or without ribavirin, achieved high sustained virological response rates in patients with HCV infection and advanced liver disease in a real-world cohort. Gut. 2016;65:1861–70.CrossRefGoogle Scholar
  6. 6.
    Goel A, Bhargava R, Rai P, Aggarwal R. Treatment of chronic genotype-3 hepatitis C virus infection using direct-acting antiviral agents: an Indian experience. Indian J Gastroenterol. 2017;36:227–34.CrossRefGoogle Scholar
  7. 7.
    Goel A, Bhadauria DS, Kaul A, et al. Experience with direct acting anti-viral agents for treating hepatitis C virus infection in renal transplant recipients. Indian J Gastroenterol. 2017;36:137–40.CrossRefGoogle Scholar
  8. 8.
    Taneja S, Duseja A, De A, et al. Successful treatment of chronic hepatitis C infection with directly acting antivirals in renal transplant recipients. Nephrology (Carlton). 2018;23:876–82.CrossRefGoogle Scholar
  9. 9.
    World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. 2016. Available from: http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/. Accessed 21 Oct 2018.
  10. 10.
    Fabrizi F, Marcelli D, Bacchini G, Guarnori I, Erba G, Locatelli F. Antibodies to hepatitis C virus (HCV) in chronic renal failure (CRF) patients on conservative therapy: prevalence, risk factors and relationship to liver disease. Nephrol Dial Transplant. 1994;9:780–4.Google Scholar
  11. 11.
    Garcia-Valdecasas J, Bernal C, Garcia F, et al. Epidemiology of hepatitis C virus infection in patients with renal disease. J Am Soc Nephrol. 1994;5:186–92.Google Scholar
  12. 12.
    Sit D, Kadiroglu AK, Kayabasi H, Yilmaz ME, Goral V. Seroprevalence of hepatitis B and C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey. Intervirology. 2007;50:133–7.CrossRefGoogle Scholar
  13. 13.
    Lemos LB, Perez RM, Lemos MM, et al. Hepatitis C among predialysis patients: prevalence and characteristics in a large cohort of patients. Nephron Clin Pract. 2008;108:c135–40.CrossRefGoogle Scholar
  14. 14.
    Goel A, Seguy N, Aggarwal R. Burden of hepatitis C virus infection in India: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2018; (in press).  https://doi.org/10.1111/jgh.14466.
  15. 15.
    Li Cavoli G, Ferrantelli A, Bono L, et al. Incidence of hepatitis C virus infection in patients with chronic kidney disease on conservative therapy. Int J Infect Dis. 2011;15:e514–6.CrossRefGoogle Scholar
  16. 16.
    Rahnavardi M, Hosseini Moghaddam SM, Alavian SM. Hepatitis C in hemodialysis patients: current global magnitude, natural history, diagnostic difficulties, and preventive measures. Am J Nephrol. 2008;28:628–40.CrossRefGoogle Scholar
  17. 17.
    Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2008;73suppl 109:S1–99.Google Scholar
  18. 18.
    Johnson DW, Dent H, Yao Q, et al. Frequencies of hepatitis B and C infections among haemodialysis and peritoneal dialysis patients in Asia-Pacific countries: analysis of registry data. Nephrol Dial Transplant. 2009;24:1598–603.CrossRefGoogle Scholar
  19. 19.
    Su Y, Norris JL, Zang C, Peng Z, Wang N. Incidence of hepatitis C virus infection in patients on hemodialysis: a systematic review and meta-analysis. Hemodial Int. 2013;17:532–41.Google Scholar
  20. 20.
    Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int. 2004;65:2335–42.CrossRefGoogle Scholar
  21. 21.
    Fabrizi F, Messa P, Martin P. Transmission of hepatitis C virus infection in hemodialysis: current concepts. Int J Artif Organs. 2008;31:1004–16.CrossRefGoogle Scholar
  22. 22.
    Karkar A. Infection control guidelines in hemodialysis facilities. Kidney Res Clin Pract. 2018;37:1–3.CrossRefGoogle Scholar
  23. 23.
    Caramelo C, de Sequera P, Lopez MD, Ortiz A. Hand-borne mechanisms of dissemination of hepatitis C virus in dialysis units: basis for new addenda to the present preventive strategies. Clin Nephrol. 1999;51:59–60.Google Scholar
  24. 24.
    Samandari T, Malakmadze N, Balter S, et al. A large outbreak of hepatitis B virus infections associated with frequent injections at a physician's office. Infect Control Hosp Epidemiol. 2005;26:745–50.CrossRefGoogle Scholar
  25. 25.
    Bender TJ, Wise ME, Utah O, et al. Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility-Virginia, 2010. PLoS One. 2012;7:e50012.CrossRefGoogle Scholar
  26. 26.
    Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis. 2010;56:371–8.CrossRefGoogle Scholar
  27. 27.
    Girou E, Chevaliez S, Challine D, et al. Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit. Clin Infect Dis. 2008;47:627–33.CrossRefGoogle Scholar
  28. 28.
    Caramelo C, Navas S, Alberola ML, Bermejillo T, Reyero A, Carreno V. Evidence against transmission of hepatitis C virus through hemodialysis ultrafiltrate and peritoneal fluid. Nephron. 1994;66:470–3.CrossRefGoogle Scholar
  29. 29.
    dos Santos JP, Loureiro A, Cendoroglo Neto M, Pereira BJ. Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant. 1996;11:2017–22.CrossRefGoogle Scholar
  30. 30.
    Jadoul M, Poignet JL, Geddes C, et al. The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis: European multicentre study. Nephrol Dial Transplant. 2004;19:904–9.CrossRefGoogle Scholar
  31. 31.
    Thompson ND, Novak RT, Datta D, et al. Hepatitis C virus transmission in hemodialysis units: importance of infection control practices and aseptic technique. Infect Control Hosp Epidemiol. 2009;30:900–3.CrossRefGoogle Scholar
  32. 32.
    Izopet J, Pasquier C, Sandres K, Puel J, Rostaing L. Molecular evidence for nosocomial transmission of hepatitis C virus in a French hemodialysis unit. J Med Virol. 1999;58:139–44.CrossRefGoogle Scholar
  33. 33.
    Jadoul M, Cornu C, van Ypersele de Strihou C. Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian multicenter study. The Universitaires Cliniques St-Luc (UCL) collaborative group. Kidney Int. 1998;53:1022–5.CrossRefGoogle Scholar
  34. 34.
    Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep. 2001;50:1–43.Google Scholar
  35. 35.
    Bravo Zuniga JI, Loza Munarriz C, Lopez-Alcalde J. Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units. Cochrane Database Syst Rev. 2016:CD006420.Google Scholar
  36. 36.
    Seeff LB. Natural history of chronic hepatitis C. Hepatology. 2002;36:S35–46.Google Scholar
  37. 37.
    Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol. 2014;61:S58–68.CrossRefGoogle Scholar
  38. 38.
    Furusyo N, Hayashi J, Kakuda K, et al. Acute hepatitis C among Japanese hemodialysis patients: a prospective 9-year study. Am J Gastroenterol. 2001;96:1592–600.CrossRefGoogle Scholar
  39. 39.
    Espinosa M, Martin-Malo A, Alvarez de Lara MA, Gonzalez R, Rodriguez M, Aljama P. Natural history of acute HCV infection in hemodialysis patients. Clin Nephrol. 2002;58:143–50.CrossRefGoogle Scholar
  40. 40.
    Hu KQ, Lee SM, Hu SX, Xia VW, Hillebrand DJ, Kyulo NL. Clinical presentation of chronic hepatitis C in patients with end-stage renal disease and on hemodialysis versus those with normal renal function. Am J Gastroenterol. 2005;100:2010–8.CrossRefGoogle Scholar
  41. 41.
    Martin P, Carter D, Fabrizi F, et al. Histopathological features of hepatitis C in renal transplant candidates. Transplantation. 2000;69:1479–84.CrossRefGoogle Scholar
  42. 42.
    Liu CH, Liang CC, Huang KW, et al. Transient elastography to assess hepatic fibrosis in hemodialysis chronic hepatitis C patients. Clin J Am Soc Nephrol. 2011;6:1057–65.CrossRefGoogle Scholar
  43. 43.
    Fabrizi F, Martin P, Dixit V, Bunnapradist S, Dulai G. Meta-analysis: effect of hepatitis C virus infection on mortality in dialysis. Aliment Pharmacol Ther. 2004;20:1271–7.CrossRefGoogle Scholar
  44. 44.
    Fabrizi F, Takkouche B, Lunghi G, Dixit V, Messa P, Martin P. The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat. 2007;14:697–703.Google Scholar
  45. 45.
    Goodkin DA, Bieber B, Jadoul M, Martin P, Kanda E, Pisoni RL. Mortality, hospitalization, and quality of life among patients with hepatitis C infection on hemodialysis. Clin J Am Soc Nephrol. 2017;12:287–97.CrossRefGoogle Scholar
  46. 46.
    Chou CY, Wang IK, Liu JH, Lin HH, Wang SM, Huang CC. Comparing survival between peritoneal dialysis and hemodialysis treatment in ESRD patients with chronic hepatitis C infection. Perit Dial Int. 2010;30:86–90.Google Scholar
  47. 47.
    Johnson RJ, Gretch DR, Yamabe H, et al. Membranoproliferative glomerulonephritis associated with hepatitis C virus infection. N Engl J Med. 1993;328:465–70.CrossRefGoogle Scholar
  48. 48.
    Davda R, Peterson J, Weiner R, Croker B, Lau JY. Membranous glomerulonephritis in association with hepatitis C virus infection. Am J Kidney Dis. 1993;22:452–5.CrossRefGoogle Scholar
  49. 49.
    Okada K, Takishita Y, Shimomura H, et al. Detection of hepatitis C virus core protein in the glomeruli of patients with membranous glomerulonephritis. Clin Nephrol. 1996;45:71–6.Google Scholar
  50. 50.
    Moe SM, Pampalone AJ, Ofner S, Rosenman M, Teal E, Hui SL. Association of hepatitis C virus infection with prevalence and development of kidney disease. Am J Kidney Dis. 2008;51:885–92.CrossRefGoogle Scholar
  51. 51.
    Lai TS, Lee MH, Yang HI, et al. High hepatitis C viral load and genotype 2 are strong predictors of chronic kidney disease. Kidney Int. 2017;92:703–9.CrossRefGoogle Scholar
  52. 52.
    Kurbanova N, Qayyum R. Association of hepatitis C virus infection with proteinuria and glomerular filtration rate. Clin Transl Sci. 2015;8:421–4.CrossRefGoogle Scholar
  53. 53.
    Fabrizi F, Verdesca S, Messa P, Martin P. Hepatitis C virus infection increases the risk of developing chronic kidney disease: a systematic review and meta-analysis. Dig Dis Sci. 2015;60:3801–13.CrossRefGoogle Scholar
  54. 54.
    Fabrizi F, Donato FM, Messa P. Association between hepatitis C virus and chronic kidney disease: a systematic review and meta-analysis. Ann Hepatol. 2018;17:364–91.CrossRefGoogle Scholar
  55. 55.
    Lai TS, Lee MH, Yang HI, et al. Hepatitis C viral load, genotype, and increased risk of developing end-stage renal disease: REVEAL-HCV study. Hepatology. 2017;66:784–93.CrossRefGoogle Scholar
  56. 56.
    Daghestani L, Pomeroy C. Renal manifestations of hepatitis C infection. Am J Med. 1999;106:347–54.CrossRefGoogle Scholar
  57. 57.
    Ishizaka N, Ishizaka Y, Takahashi E, et al. Association between hepatitis C virus seropositivity, carotid-artery plaque, and intima-media thickening. Lancet. 2002;359:133–5.CrossRefGoogle Scholar
  58. 58.
    Alavian SM, Taheri S. Inauspicious contribution of hepatitis C virus and diabetes mellitus targeting kidneys: an update. Iran J Kidney Dis. 2012;6:236–54.Google Scholar
  59. 59.
    Sise ME, Backman E, Ortiz GA, et al. Effect of sofosbuvir-based hepatitis C virus therapy on kidney function in patients with CKD. Clin J Am Soc Nephrol. 2017;12:1615–23.CrossRefGoogle Scholar
  60. 60.
    Gretch DR. Diagnostic tests for hepatitis C. Hepatology. 1997;26:43S–7S.CrossRefGoogle Scholar
  61. 61.
    Lakshmi V, Reddy AK, Dakshinamurty KV. Evaluation of commercially available third-generation anti-hepatitis C virus enzyme-linked immunosorbent assay in patients on haemodialysis. Indian J Med Microbiol. 2007;25:140–2.CrossRefGoogle Scholar
  62. 62.
    Kalantar-Zadeh K, Miller LG, Daar ES. Diagnostic discordance for hepatitis C virus infection in hemodialysis patients. Am J Kidney Dis. 2005;46:290–300.CrossRefGoogle Scholar
  63. 63.
    Freiman JM, Tran TM, Schumacher SG, et al. Hepatitis C core antigen testing for diagnosis of hepatitis C virus infection: a systematic review and meta-analysis. Ann Intern Med. 2016;165:345–55.CrossRefGoogle Scholar
  64. 64.
    Trevizoli JE, de Paula MR, Ribeiro Velasco LF, et al. Hepatitis C is less aggressive in hemodialysis patients than in nonuremic patients. Clin J Am Soc Nephrol. 2008;3:1385–90.CrossRefGoogle Scholar
  65. 65.
    Saab S, Martin P, Brezina M, Gitnick G, Yee HF Jr. Serum alanine aminotransferase in hepatitis C screening of patients on hemodialysis. Am J Kidney Dis. 2001;37:308–15.CrossRefGoogle Scholar
  66. 66.
    Ashfaq UA, Javed T, Rehman S, Nawaz Z, Riazuddin S. An overview of HCV molecular biology, replication and immune responses. Virol J. 2011;8:161.CrossRefGoogle Scholar
  67. 67.
    Pawlotsky JM. Hepatitis C virus resistance to direct-acting antiviral drugs in interferon-free regimens. Gastroenterology. 2016;151:70–86.CrossRefGoogle Scholar
  68. 68.
    Nookathota M, Mukherjee S. Antiviral therapy for chronic hepatitis C in 2014. Expert Rev Clin Pharmacol. 2014;7:499–505.CrossRefGoogle Scholar
  69. 69.
    Simmons B, Saleem J, Hill A, Riley RD, Cooke GS. Risk of late relapse or reinfection with hepatitis C virus after achieving a sustained virological response: a systematic review and meta-analysis. Clin Infect Dis. 2016;62:683–94.CrossRefGoogle Scholar
  70. 70.
    AASLD-IDSA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed 21 Oct 2018.
  71. 71.
    EASL. Recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69:461–511.CrossRefGoogle Scholar
  72. 72.
    Gane EJ, Robson RA, Bonacini M, et al. Anti-viral efficacy and pharmacokinetics (PK) of sofosbuvir (SOF) in patients with severe renal impairment. Hepatology. 2014;60:667A.Google Scholar
  73. 73.
    Roth D, Nelson DR, Bruchfeld A, et al. Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet. 2015;386:1537–45.CrossRefGoogle Scholar
  74. 74.
    Gane E, Lawitz E, Pugatch D, et al. Glecaprevir and pibrentasvir in patients with HCV and severe renal impairment. N Engl J Med. 2017;377:1448–55.CrossRefGoogle Scholar
  75. 75.
    Goel A, Bhadauria DS, Kaul A, et al. Daclatasvir and reduced-dose sofosbuvir: an effective and pangenotypic treatment for hepatitis C in patients with eGFR <30 ml/min. Nephrology (Carlton). 2018: (in press). doi:  https://doi.org/10.1111/nep.13222.
  76. 76.
    He YL, Yang SJ, Hu CH, et al. Safety and efficacy of sofosbuvir-based treatment of acute hepatitis C in end-stage renal disease patients undergoing haemodialysis. Aliment Pharmacol Ther. 2018;47:526–32.CrossRefGoogle Scholar
  77. 77.
    Taneja S, Duseja A, De A, et al. Low-dose Sofosbuvir is safe and effective in treating chronic hepatitis C in patients with severe renal impairment or end-stage renal disease. Dig Dis Sci. 2018;63:1334–40.CrossRefGoogle Scholar
  78. 78.
    Goel A, Chen Q, Chhatwal J, Aggarwal R. Cost-effectiveness of generic pan-genotypic sofosbuvir/velpatasvir versus genotype-dependent direct-acting antivirals for hepatitis C treatment. J Gastroenterol Hepatol. 2018; (in press).  https://doi.org/10.1111/jgh.14301.
  79. 79.
    Prasad N, Patel MR, Pandey A, et al. Direct-acting antiviral agents in hepatitis C virus-infected renal allograft recipients: treatment and outcome experience from single center. Indian J Nephrol. 2018;28:220–5.CrossRefGoogle Scholar
  80. 80.
    Kamar N, Marion O, Rostaing L, et al. Efficacy and safety of Sofosbuvir-based antiviral therapy to treat hepatitis C virus infection after kidney transplantation. Am J Transplant. 2016;16:1474–9.CrossRefGoogle Scholar
  81. 81.
    Sise ME, Chute DF, Gustafson JL, et al. Transplantation of hepatitis C virus infected kidneys into hepatitis C virus uninfected recipients. Hemodial Int. 2018;22Suppl 1:S71–80.Google Scholar
  82. 82.
    Scalea JR, Barth RN, Munivenkatappa R, et al. Shorter waitlist times and improved graft survivals are observed in patients who accept hepatitis C virus+ renal allografts. Transplantation. 2015;99:1192–6.CrossRefGoogle Scholar
  83. 83.
    Goldberg DS, Abt PL, Blumberg EA, et al. Trial of transplantation of HCV-infected kidneys into uninfected recipients. N Engl J Med. 2017;376:2394–5.CrossRefGoogle Scholar
  84. 84.
    Durand CM, Bowring MG, Brown DM, et al. Direct-acting antiviral prophylaxis in kidney transplantation from hepatitis C virus-infected donors to noninfected recipients: an open-label nonrandomized trial. Ann Intern Med. 2018;168:533–40.CrossRefGoogle Scholar
  85. 85.
    Campos-Varela I, Agudelo EZ, Sarkar M, Roberts JP, Terrault NA. Use of a hepatitis C virus (HCV) RNA-positive donor in a treated HCV RNA-negative liver transplant recipient. Transpl Infect Dis. 2018;20: (in press).  https://doi.org/10.1111/tid.12809.
  86. 86.
    Coilly A, Samuel D. Pros and cons: usage of organs from donors infected with hepatitis C virus—revision in the direct-acting antiviral era. J Hepatol. 2016;64:226–31.CrossRefGoogle Scholar
  87. 87.
    Trotter PB, Summers DM, Ushiro-Lumb I, et al. Use of organs from hepatitis C virus-positive donors for uninfected recipients: a potential cost-effective approach to save lives? Transplantation. 2018;102:664–72.CrossRefGoogle Scholar
  88. 88.
    Chhatwal J, Kanwal F. Cost-effectiveness and decision analysis in clinical gastroenterology and hepatology: from evidence to informed decision making. Clin Gastroenterol Hepatol. 2018;16:459–61.CrossRefGoogle Scholar
  89. 89.
    Chhatwal J, Kanwal F, Roberts MS, Dunn MA. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States. Ann Intern Med. 2015;162:397–406.CrossRefGoogle Scholar
  90. 90.
    Aggarwal R, Chen Q, Goel A, et al. Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India. PLoS One. 2017;12:e0176503.CrossRefGoogle Scholar
  91. 91.
    Bethea ED, Chen Q, Hur C, Chung RT, Chhatwal J. Should we treat acute hepatitis C? A decision and cost-effectiveness analysis. Hepatology. 2018;67:837–46.CrossRefGoogle Scholar
  92. 92.
    Elbasha E, Greaves W, Roth D, Nwankwo C. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States. J Viral Hepat. 2017;24:268–79.CrossRefGoogle Scholar
  93. 93.
    Shelton BA, Sawinski D, Linas BP, et al. Population level outcomes and cost-effectiveness of hepatitis C treatment pre- vs postkidney transplantation. Am J Transplant. 2018;18:2483–95.CrossRefGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of NephrologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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