Gupta Ankur, Arora Puneet, Jain Priyanka
Department of Gastroenterology, Max Super Speciality Hospital, Malsi, Dehradun, Uttarakhand 248001, India.
Department of Nephrology, Max Super Speciality Hospital, Malsi, Dehradun, Uttarakhand 248001, India.
J Clin Exp Hepatol. 2018 Jun;8(2):116-120. doi: 10.1016/j.jceh.2017.10.001. Epub 2017 Nov 10.
Hepatitis C infection is known to increase the morbidity in patients with end stage renal disease (ESRD). Interferon based treatment is poorly tolerated and has limited cure rates in these patients. In limited available data, sofosbuvir based regimens have been shown to have favorable outcomes in these patients.
We treated 7 patients with ESRD on hemodialysis, 6 with chronic hepatitis C and one with acute hepatitis C. Two of them were cirrhotic of which one was decompensated. All patients were treated with sofosbuvir 200 mg with daclatasvir 60 mg or ribavirin 200 mg once daily. Patients with evidence of cirrhosis were treated for 24 weeks, others were treated for 12 weeks. HCV RNA quantitative PCR was monitored at weeks 2, 4, 12, end of therapy and after 12 weeks of end of treatment (SVR12).
The study cohort included five males and two females, aged (48.4 ± 14.5 years). Four patients had genotype 1 and three had genotype 3. One patient was treated with sofosbuvir and ribavirin while others were treated with sofosbuvir and daclatasvir. One patient died of unrelated cause during the therapy. One patient who received sofosbuvir and daclatasvir, could not complete the therapy beyond 20 weeks because she developed recurrent hypoglycemia, which improved after stopping the therapy, all the other patients had SVR 12. There was no change in Hb levels or erythropoietin requirement in the patients receiving sofosbuvir and daclatasvir.
Our data suggest that sofosbuvir based therapy is effective in patients with ESRD and hepatitis C, including those with liver cirrhosis. Its use may be recommended especially in countries where other drugs are not available. Due to limited experience however, patients should be closely monitored for adverse effects. Hypoglycemia may be a potential adverse effect of sofosbuvir and daclatasvir therapy.
已知丙型肝炎感染会增加终末期肾病（ESRD）患者的发病率。基于干扰素的治疗耐受性差，且这些患者的治愈率有限。在有限的可用数据中，基于索磷布韦的治疗方案已被证明在这些患者中具有良好的疗效。
我们治疗了7例接受血液透析的ESRD患者，其中6例为慢性丙型肝炎，1例为急性丙型肝炎。其中2例为肝硬化患者，其中1例为失代偿期。所有患者均接受每日一次200毫克索磷布韦与60毫克达卡他韦或200毫克利巴韦林的治疗。有肝硬化证据的患者接受24周治疗，其他患者接受12周治疗。在第2、4、12周、治疗结束时以及治疗结束后12周（SVR12）监测HCV RNA定量PCR。
研究队列包括5名男性和2名女性，年龄（48.4±14.5岁）。4例患者为基因1型，3例为基因3型。1例患者接受索磷布韦和利巴韦林治疗，其他患者接受索磷布韦和达卡他韦治疗。1例患者在治疗期间死于无关原因。1例接受索磷布韦和达卡他韦治疗的患者，由于出现反复低血糖，在20周后无法完成治疗，停药后低血糖情况改善，所有其他患者均实现了SVR 12。接受索磷布韦和达卡他韦治疗的患者的血红蛋白水平或促红细胞生成素需求没有变化。
我们的数据表明，基于索磷布韦的治疗对ESRD合并丙型肝炎患者有效，包括那些患有肝硬化的患者。尤其在没有其他药物的国家，可能推荐使用该治疗方法。然而，由于经验有限，应密切监测患者的不良反应。低血糖可能是索磷布韦和达卡他韦治疗的潜在不良反应。
