Choudhary Narendra S, Kumar Amit, Bodh Vijay, Bansal Shyam Bihari, Sharma Reetesh, Jain Manish, Saigal Sanjiv, Saraf Neeraj
Medanta Liver Institute, Medanta The Medicity, Gurgaon, Haryana, 122 018, India.
Medanta Kidney Institute, Medanta The Medicity, Gurgaon, Haryana, 122 018, India.
Indian J Gastroenterol. 2017 Mar;36(2):113-116. doi: 10.1007/s12664-017-0735-7. Epub 2017 Mar 9.
Patients with end-stage renal disease (ESRD) have poor treatment tolerance and outcome to interferon-based regimens. Sofosbuvir-based regimens have improved treatment success in chronic hepatitis C. There is limited data in ESRD patients as sofosbuvir is excreted by the kidney. Several small studies have shown good results.
Sixteen consecutive patients of ESRD (on dialysis) and chronic hepatitis C were treated with sofosbuvir-based regimens as they were prospective kidney transplantation recipients, at a tertiary care center in north India. Sofosbuvir was given 400 mg on alternate days. Data is shown as number, mean (SD), and median (range).
Sixteen patients (12 males) aged 45±12 years received sofosbuvir-based treatment. These patients were on hemodialysis from 10 (2-48) months. Eleven of these patients had genotype 1, four had genotype 3, and one had genotype 4 infection; baseline RNA was 7 (5-8) log. The following treatment regimens were used: sofosbuvir, ribavirin, and low dose peginterferon (n = 8; 6 genotype 1 and one each had genotype 3 and 4); sofosbuvir and daclatasvir (n = 7); sofosbuvir, ribavirin, and daclatasvir (n = 1). Ten patients achieved end of treatment response and 8 (80%) of these achieved sustained virological response at 12 weeks (SVR12); six are on treatment. Two patients with genotype one (including one with cirrhosis) had relapse. Seven patients needed blood transfusion; interferon was stopped in one due to thrombocytopenia. Fatigue was present in 4 patients.
Sofosbuvir-based regimens can be used in ESRD patients on dialysis with good efficacy.
终末期肾病（ESRD）患者对基于干扰素的治疗方案耐受性差且预后不佳。基于索磷布韦的治疗方案提高了慢性丙型肝炎的治疗成功率。由于索磷布韦通过肾脏排泄，ESRD患者的数据有限。几项小型研究已显示出良好结果。
在印度北部一家三级护理中心，16例连续性ESRD（正在透析）合并慢性丙型肝炎患者接受了基于索磷布韦的治疗方案，因为他们是潜在的肾移植受者。索磷布韦每隔一天给予400毫克。数据以数量、均值（标准差）和中位数（范围）表示。
16例患者（12例男性），年龄45±12岁，接受了基于索磷布韦的治疗。这些患者已接受血液透析10（2 - 48）个月。其中11例患者为基因1型感染，4例为基因3型感染，1例为基因4型感染；基线RNA为7（5 - 8）log。采用了以下治疗方案：索磷布韦、利巴韦林和低剂量聚乙二醇干扰素（n = 8；6例基因1型，基因3型和基因4型各1例）；索磷布韦和达卡他韦（n = 7）；索磷布韦、利巴韦林和达卡他韦（n = 1）。10例患者达到治疗结束反应，其中8例（80%）在12周时实现持续病毒学应答（SVR12）；6例仍在治疗中。2例基因1型患者（包括1例肝硬化患者）复发。7例患者需要输血；1例因血小板减少而停用干扰素。4例患者出现疲劳。
基于索磷布韦的治疗方案可用于正在透析的ESRD患者，疗效良好。
