Pagan Javier, Ladino Marco, Roth David
Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida.
Nephrology Section, Miami Veterans Administration Healthcare System, Miami, Florida.
Semin Dial. 2019 Mar;32(2):152-158. doi: 10.1111/sdi.12764. Epub 2018 Nov 26.
The identification of hepatitis C virus (HCV) occurred in 1989, and soon thereafter, it was recognized that there was a higher prevalence of anti-HCV seropositivity in patients with end-stage renal disease (ESRD) when compared to the general population. Multiple extrahepatic manifestations have been associated with HCV infection in patients with ESRD; these include an increased prevalence and risk of cardiovascular complications, insulin resistance, diabetes mellitus, and lymphoproliferative disorders. Infection with HCV has also been associated with an increased relative risk of mortality in the ESRD patient when contrasted to those patients without infection. The availability of second-generation direct-acting antiviral agents has revolutionized the treatment of HCV in both the general population as well as those patients with advanced chronic kidney disease and receiving dialysis. These new treatment protocols are very well tolerated with limited side effects and manageable drug-drug interactions while achieving remarkable sustained viral response rates. It is important that nephrologists become familiar with the differing strategies available for HCV-infected ESRD patients so that the appropriate decision of when and who to treat can be made for each patient.
丙型肝炎病毒（HCV）于1989年被发现，此后不久，人们认识到与普通人群相比，终末期肾病（ESRD）患者中抗-HCV血清阳性的患病率更高。ESRD患者的HCV感染与多种肝外表现有关；这些表现包括心血管并发症、胰岛素抵抗、糖尿病和淋巴增殖性疾病的患病率和风险增加。与未感染的患者相比，HCV感染还与ESRD患者相对死亡风险增加有关。第二代直接作用抗病毒药物的出现彻底改变了普通人群以及晚期慢性肾病和接受透析患者的HCV治疗。这些新的治疗方案耐受性良好，副作用有限，药物相互作用易于管理，同时实现了显著的持续病毒学应答率。肾病学家必须熟悉针对HCV感染的ESRD患者的不同治疗策略，以便为每位患者做出何时治疗以及治疗谁的合适决定。
