Nephrology Department, Faculty of Medicine, Hedi Chaker University Hospital and UR 12ES14, Sfax, Tunisia.
Hepato-Gastroenterology Department, Hedi Chaker University Hospital, Sfax, Tunisia.
Pan Afr Med J. 2021 Feb 8;38:137. doi: 10.11604/pamj.2021.38.137.20560. eCollection 2021.
The treatment of chronic hepatitis C virus (HCV) infection in chronic hemodialysis patients remains an issue of great concern for nephrologists. In 2008 the kidney disease improving global outcomes working group suggested the use of pegylated interferon in end stage kidney disease patients treated by dialysis. Since then, series and some clinical trials on different direct-acting antiviral agents have shown better efficacy and tolerance than interferon-based regimens. Data on the efficacy, tolerance and the right dose of sofosbuvir in this population are still unclear. We report a case of chronic HCV genotype 1b infection in a 47-year-old patient on maintenance hemodialysis successfully treated by a combination of sofosbuvir and ledipasvir for 12 weeks. Evolution was marked by the complete regression of the hepatic cytolysis, a complete and sustained virologic response with HCV viral load undetectable for a 24 months follow-up period. No adverse reaction was found. The treatment of HCV genotype 1 or 4 infection in patients on maintenance hemodialysis is possible with sofosbuvir based regimens with a good efficacy/safety ratio in the absence of current recommended drugs for patients with eGFR<30ml/min/1.73m. The prescription of sofosbuvir should be encouraged amongst this population in this setting.
慢性丙型肝炎病毒 (HCV) 感染的治疗在慢性血液透析患者中仍然是肾病学家非常关注的问题。2008 年，肾脏病改善全球结局工作组建议在接受透析治疗的终末期肾脏病患者中使用聚乙二醇干扰素。从那时起，一系列不同直接作用抗病毒药物的临床试验表明，与基于干扰素的方案相比，它们具有更好的疗效和耐受性。关于该人群中索非布韦的疗效、耐受性和正确剂量的数据仍不清楚。我们报告了一例在维持性血液透析的 47 岁患者中成功治疗慢性 HCV 基因型 1b 感染的病例，该患者接受了 12 周的索非布韦和 ledipasvir 联合治疗。治疗后，肝细胞溶解完全消退，病毒学应答完全且持续，24 个月的随访期间 HCV 病毒载量不可检测。未发现不良反应。对于 eGFR<30ml/min/1.73m 的患者，没有推荐药物的情况下，使用基于索非布韦的方案治疗维持性血液透析患者的 HCV 基因型 1 或 4 感染是可能的，其疗效/安全性比值良好。在这种情况下，应鼓励在该人群中开具索非布韦。
