Treatment of Hepatitis C Virus-Infected Patients with Renal Failure
The prevalence of hepatitis C virus infection in patients with renal diseases is higher compared to the general population. On the other hand chronic HCV infection is independently associated with the development of chronic kidney disease. The selection of the most appropriate regimen depends on genotype, presence or absence of cirrhosis, prior treatment history, and, in patients with renal failure, degree of renal impairment. Since HCV infection in end-stage renal disease patients may lead to increased risk of all-cause and liver-related mortality, HCV-infected patients with renal impairment should be considered for antiviral therapy. According to the major guidelines fixed-dose combination of glecaprevir/pibrentasvir is the recommended regimen for all genotypes for 8–16 weeks. Fixed-dose combination of elbasvir/grazoprevir is recommended for genotypes 1a–b and genotype 4 for 12 weeks. Paritaprevir, ritonavir, ombitasvir, and dasabuvir with or without ribavirin are other alternatives for patients with severe renal impairment or with end-stage renal disease infected with genotype 1a or genotype 4. But in resource-limited areas where directly acting antivirals are not available pegylated interferon and ribavirin may still be the only alternatives for treatment especially in patients infected with genotypes 2 and 3.
KeywordsHepatitis C Treatment Renal failure Directly acting antivirals
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