Sorbonne Universités, UPMC Université Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005 Paris, France; INSERM, UMR_S 959, F-75013 Paris, France; CNRS, FRE3632, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013 Paris, France.
Sorbonne Universités, UPMC Université Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005 Paris, France; INSERM, UMR_S 959, F-75013 Paris, France; CNRS, FRE3632, F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013 Paris, France.
J Hepatol. 2016 Oct;65(1 Suppl):S82-S94. doi: 10.1016/j.jhep.2016.06.011.
Hepatitis C virus (HCV) infection is associated with tremendous morbidity and mortality due to liver complications. HCV infection is also associated with many extrahepatic manifestations including cardiovascular diseases, glucose metabolism impairment, cryoglobulinemia vasculitis, B cell non-Hodgkin lymphoma and chronic kidney disease (CKD). Many studies have shown a strong association between HCV and CKD, by reporting (i) an increased prevalence of HCV infection in patients on haemodialysis, (ii) an increased incidence of CKD and proteinuria in HCV-infected patients, and (iii) the development of membranoproliferative glomerulonephritis secondary to HCV-induced cryoglobulinemia vasculitis. HCV seropositivity is found to be associated with an increased relative risk for all-cause and cardiovascular mortality in the dialysis population. HCV seropositivity is linked to lower patient and graft survival after kidney transplantation. Such poor HCV-associated prognosis should have encouraged clinicians to treat HCV in CKD patients. However, due to frequent side effects and the poor efficacy of interferon-based treatments, very few HCV dialysis patients have received HCV medications until now. The emergence of new direct acting, interferon-free antiviral treatment, leading to HCV cure in most cases with a satisfactory safety profile, will shortly modify the management of HCV infection in CKD patients. In patients with a glomerular filtration rate (GFR) >30ml/min, the choice of DAA is not restricted. In those with a GFR <30 and >15ml/min, only paritaprevir/ritonavir/ombitasvir/dasabuvir or a grazoprevir plus elbasvir regimen are approved. In patients with end stage renal disease (GFR <15ml/min or dialysis), current data only allows for the use of a grazoprevir plus elbasvir combination. No doubt these data will be modified in the future with the advent of new studies including larger cohorts of HCV patients with renal impairment.
丙型肝炎病毒（HCV）感染可导致肝脏并发症，从而引起巨大的发病率和死亡率。HCV 感染还与许多肝外表现相关，包括心血管疾病、葡萄糖代谢损伤、冷球蛋白血症血管炎、B 细胞非霍奇金淋巴瘤和慢性肾脏病（CKD）。许多研究表明，HCV 与 CKD 之间存在很强的关联，这些研究通过报告（i）血液透析患者中 HCV 感染的患病率增加，（ii）HCV 感染患者 CKD 和蛋白尿的发生率增加，以及（iii）HCV 诱导的冷球蛋白血症血管炎继发的膜性增殖性肾小球肾炎的发展，来证明这一点。HCV 血清阳性与透析人群全因和心血管死亡率的相对风险增加相关。HCV 血清阳性与肾移植后患者和移植物的存活率降低相关。如此不良的 HCV 相关预后本应鼓励临床医生治疗 CKD 患者的 HCV。然而，由于干扰素治疗的副作用频繁且疗效不佳，到目前为止，只有极少数 HCV 透析患者接受了 HCV 药物治疗。新的直接作用、无干扰素抗病毒治疗的出现，使大多数情况下 HCV 得以治愈，且具有良好的安全性，不久后将改变 CKD 患者 HCV 感染的治疗方法。肾小球滤过率（GFR）>30ml/min 的患者，可不受限制地选择 DAA。GFR<30 且>15ml/min 的患者，仅批准使用帕利瑞韦/利托那韦/奥比他韦/达萨布韦或格卡瑞韦/哌仑他韦联合利巴韦林方案。终末期肾病（GFR<15ml/min 或透析）患者，目前的数据仅允许使用格卡瑞韦/哌仑他韦联合利巴韦林方案。随着包括更多伴有肾损伤的 HCV 患者的大型队列研究的出现，无疑这些数据将在未来得到修正。
