Salvadori Maurizio, Tsalouchos Aris
Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy.
Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Pescia 51017, Italy.
World J Transplant. 2018 Aug 9;8(4):84-96. doi: 10.5500/wjt.v8.i4.84.
Data from World Health Organization estimates that the hepatitis C virus (HCV) prevalence is 3% and approximately 71 million persons are infected worldwide. HCV infection is particularly frequent among patients affected by renal diseases and among those in dialysis treatment. In addition to produce a higher rate of any cause of death, HCV in renal patients and in renal transplanted patients produce a deterioration of liver disease and is a recognized cause of transplant glomerulopathy, new onset diabetes mellitus and lymphoproliferative disorders. Treatment of HCV infection with interferon alpha and/or ribavirin had a poor efficacy. The treatment was toxic, expensive and with limited efficacy. In the post-transplant period was also cause of severe humoral rejection. In this review we have highlighted the new direct antiviral agents that have revolutionized the treatment of HCV both in the general population and in the renal patients. Patients on dialysis or with low glomerular filtration rate were particularly resistant to the old therapies, while the direct antiviral agents allowed achieving a sustained viral response in 90%-100% of patients with a short period of treatment. This fact to date allows HCV patients to enter the waiting list for transplantation easier than before. These new agents may be also used in renal transplant patients HCV-positive without relevant clinical risks and achieving a sustained viral response in almost all patients. New drug appears in the pipeline with increased profile of efficacy and safety. These drugs are now the object of several phases II, III clinical trials.
世界卫生组织的数据估计，丙型肝炎病毒（HCV）的全球流行率为3%，全球约有7100万人感染。HCV感染在肾病患者和接受透析治疗的患者中尤为常见。除了导致任何原因的死亡率升高外，HCV在肾病患者和肾移植患者中还会使肝脏疾病恶化，并且是移植性肾小球病、新发糖尿病和淋巴增殖性疾病的公认病因。用α干扰素和/或利巴韦林治疗HCV感染疗效不佳。该治疗有毒、昂贵且疗效有限。在移植后阶段，它也是严重体液排斥反应的原因。在本综述中，我们重点介绍了新型直接抗病毒药物，这些药物彻底改变了普通人群和肾病患者中HCV的治疗方式。透析患者或肾小球滤过率低的患者对旧疗法特别耐药，而直接抗病毒药物能使90%-100%的患者在短疗程治疗后实现持续病毒学应答。迄今为止，这一事实使HCV患者比以前更容易进入移植等待名单。这些新型药物也可用于HCV阳性且无相关临床风险的肾移植患者，并使几乎所有患者实现持续病毒学应答。有新的药物正在研发中，其疗效和安全性不断提高。这些药物目前正处于多项II期、III期临床试验阶段。
