Effect and Safety of Daclatasvir-Asunaprevir Combination Therapy for Chronic Hepatitis C Virus Genotype 1b -Infected Patients on Hemodialysis.

The prevalence of anti-hepatitis C virus (HCV)antibodies is higher in hemodialysis patients than in the general population, and several studies have reported poor vital prognosis in HCV-infected dialysis patients because infection with HCV is not only the cause of cirrhosis and hepatocellular carcinoma, but also a risk factor for cardiovascular disease. Although sustained virologic response (SVR) is achievable with interferon and ribavirin in dialysis patients, SVR rates are lower, and the use of ribavirin is challenging because of the risk of hemolytic anemia. Recently, interferon-ribavirin free direct acting antivirals (DAAs) treatment has shown strong efficacy and fewer adverse events for chronic HCV infection patients without using dialysis, but there are few reports about DAAs for such patients. Thus, we conducted a study to examine the effect and safety of daclatasvir and asunaprevir in chronic hepatitis C virus genotype 1b-infected hemodialysis patients. We treated 10 patients: seven males and three females. Before treatment, we detected resistance-associated variants on the NS5A region, which is the L31M site variant, in two patients. Although two patients showed resistance-associated variant, all the patients showed quick disappearance of HCV RNA in the serum and achieved a SVR12. During this therapy, no patients displayed abnormal liver function during treatment. Two patients experienced diarrhea and another one patient complained of nausea soon after treatment but these were relieved by symptomatic therapy. We report good results of treatment for chronic hepatitis C virus genotype 1b -infected patients on hemodialysis with all oral DAAs (daclatasvir and asunaprevir).