Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Viral Hepat. 2018 Dec;25(12):1501-1506. doi: 10.1111/jvh.12983. Epub 2018 Sep 11.
Treatment of Hepatitis C virus (HCV) in patients with severe renal insufficiency is cumbersome as sofosbuvir is mainly excreted by the kidneys. There is paucity of data on the use of sofosbuvir and NS5A inhibitors in these patients. We hereby report our experience of treating chronic hepatitis C in patients with severe renal insufficiency with full dose sofosbuvir and NS5A inhibitors. Forty-seven patients with severe renal insufficiency (on dialysis n = 39, predialysis n = 8) with HCV infection were treated between December 2015-August 2017 with full dose sofosbuvir with ledipasvir or daclatasvir for 12/24 weeks depending on the genotype and the presence or absence of cirrhosis. The distribution of HCV genotype was genotype 1 in 32 (68.1%), genotype 3 in 13 (27.7%) and 4 in 2 (4.3%) patients. Among 12 (25.5%) patients with cirrhosis, 7 (14.9%) were decompensated with ascites. All patients had end of treatment response, and sustained viral response at 12 weeks was achieved in 45 (95.7%) patients. There was significant improvement in liver stiffness at 3 months after treatment (8.8 (3.8-42) to 7.1 (3.3-24.1) kPa; (P = 0.047)). There was no change in haemoglobin and eGFR with treatment in predialysis group (haemoglobin- 10.2 ± 1.5 g/dL vs 9.6 ± 1.3 g/dL, P = 0.44; eGFR- 19.8 ± 9.4 mL/min vs 17.9 ± 8.5 mL/min, P = 0.67). Therapy was very well accepted. Full dose sofosbuvir with NS5A inhibitors is a well tolerated and effective therapy for HCV infection in severe renal insufficiency.
治疗严重肾功能不全患者的丙型肝炎病毒 (HCV) 较为棘手，因为索非布韦主要通过肾脏排泄。目前关于这些患者使用索非布韦和 NS5A 抑制剂的数据很少。我们在此报告我们使用全剂量索非布韦和 NS5A 抑制剂治疗严重肾功能不全合并慢性丙型肝炎患者的经验。2015 年 12 月至 2017 年 8 月，我们共治疗了 47 例严重肾功能不全（透析 n = 39，透析前 n = 8）合并 HCV 感染的患者，根据基因型以及是否存在肝硬化，给予全剂量索非布韦联合利巴韦林或达卡他韦治疗 12 或 24 周。HCV 基因型分布为 1 型 32 例（68.1%）、3 型 13 例（27.7%）和 4 型 2 例（4.3%）。在 12 例（25.5%）肝硬化患者中，有 7 例（14.9%）为失代偿性腹水。所有患者均获得了治疗结束时的应答，45 例（95.7%）患者在 12 周时获得了持续病毒学应答。治疗 3 个月后，肝硬度明显改善（8.8（3.8-42）至 7.1（3.3-24.1）kPa；P = 0.047）。在透析前组中，治疗前后血红蛋白和 eGFR 无变化（血红蛋白- 10.2 ± 1.5 g/dL 与 9.6 ± 1.3 g/dL，P = 0.44；eGFR- 19.8 ± 9.4 mL/min 与 17.9 ± 8.5 mL/min，P = 0.67）。治疗效果很好，全剂量索非布韦联合 NS5A 抑制剂是治疗严重肾功能不全合并丙型肝炎病毒感染的一种耐受良好且有效的治疗方法。
