Sperl Jan, Frankova Sona, Kreidlova Miluse, Merta Dusan, Tothova Monika, Spicak Julius
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine.
Institute of Medical Biochemistry and Laboratory Medicine, General University Hospital, Charles University.
Ther Clin Risk Manag. 2017 Jun 22;13:733-738. doi: 10.2147/TCRM.S133983. eCollection 2017.
Chronic hepatitis C virus infection (HCV) has a negative impact on the long-term survival of recipients of kidney transplants. HCV should be treated in hemodialyzed patients before their enlistment for kidney transplantation in order to avoid the reactivation of virus after transplantation. Direct-acting antivirals represent the current standard of care in hemodialyzed patients with HCV genotypes 1 and 4; in patients with genotypes 2 or 3, the optimal regimen is yet to be established. Sofosbuvir (SOF) and daclatasvir (DCV) represent an antiviral pangenotypic regimen with favorable pharmacokinetics in hemodialyzed patients. We retrospectively evaluated safety and efficacy of the combination of SOF and DCV in the treatment of genotype 3a chronic HCV in six male patients (mean age of 39 years, range 25-53 years) with end-stage renal disease on maintenance hemodialysis; these patients were treated with a reduced dose of SOF (one half of a 400 mg tablet) and 60 mg of DCV once daily. The anticipated treatment duration was 12 weeks. Initial HCV RNA ranged from 120,000 to 11,000,000 IU/mL. Two of the six patients had compensated liver cirrhosis based on shear-wave elastography result. All of the patients completed a 12-week treatment. Viremia became negative on treatment and remained negative 12 weeks after the end of therapy in all the patients. All of them (6/6, 100%) achieved sustained virological response, including two with cirrhosis and two with HCV RNA >6,000,000 IU/mL. The treatment was well tolerated: none of the patients presented with a serious adverse event requiring hospital admission and none had anemia or any significant changes in blood count. One patient had a short period of diarrhea, which was resolved with antibiotic treatment. The combination of reduced-dose SOF and full-dose DCV, daily, was a safe and effective treatment in our group of hemodialyzed patients infected with HCV genotype 3.
慢性丙型肝炎病毒感染（HCV）对肾移植受者的长期生存有负面影响。HCV应在血液透析患者登记肾移植前进行治疗，以避免移植后病毒重新激活。直接作用抗病毒药物是目前治疗HCV基因1型和4型血液透析患者的标准治疗方法；对于基因2型或3型患者，最佳治疗方案尚未确定。索磷布韦（SOF）和达卡他韦（DCV）代表一种抗病毒泛基因型方案，在血液透析患者中具有良好的药代动力学。我们回顾性评估了SOF和DCV联合治疗6例男性（平均年龄39岁，范围25 - 53岁）维持性血液透析终末期肾病患者基因3a型慢性HCV的安全性和疗效；这些患者接受了减量的SOF（400毫克片剂的一半）和每日60毫克DCV治疗。预期治疗疗程为12周。初始HCV RNA范围为120,000至11,000,000 IU/mL。根据剪切波弹性成像结果，6例患者中有2例为代偿性肝硬化。所有患者均完成了12周的治疗。所有患者在治疗期间病毒血症转阴，治疗结束后12周仍保持阴性。所有患者（6/6，100%）均实现了持续病毒学应答，包括2例肝硬化患者和2例HCV RNA>6,000,000 IU/mL的患者。治疗耐受性良好：没有患者出现需要住院治疗的严重不良事件，也没有患者出现贫血或血细胞计数的任何显著变化。1例患者出现了短暂的腹泻，经抗生素治疗后缓解。每日给予减量SOF和全量DCV联合治疗，对于我们这组感染HCV基因3型的血液透析患者是一种安全有效的治疗方法。
