Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Hepatol Int. 2022 Oct;16(5):1001-1019. doi: 10.1007/s12072-022-10390-z. Epub 2022 Jul 25.
Hepatitis C virus (HCV) infection is a major health problem with significant clinical and economic burdens in patients with chronic kidney disease (CKD) stage 4 or 5. Current guidelines recommend pan-genotypic direct-acting antivirals (DAAs) to be the first-line treatment of choice for HCV. This review summarizes the updated knowledge regarding the epidemiology, natural history, public health perspectives of HCV in patients with CKD stage 4 or 5, including those on maintenance dialysis, and the performance of pan-genotypic DAAs in these patients. The prevalence and incidence of HCV are much higher in patients with CKD stage 4 or 5 than in the general population. The prognosis is compromised if HCV patients are left untreated regardless of kidney transplantation (KT). Following treatment-induced HCV eradication, patient can improve the health-related outcomes by maintaining a long-term aviremic state. The sustained virologic response (SVR) rates and safety profiles of pan-genotypic DAAs against HCV are excellent irrespective of KT. No dose adjustment of pan-genotypic DAAs is required across CKD stages. Assessing drug-drug interactions (DDIs) before HCV treatment is vital to secure on-treatment safety. The use of prophylactic or preemptive pan-genotypic DAAs in HCV-negative recipients who receive HCV-positive kidneys has shown promise in shortening KT waiting time, achieving excellent on-treatment efficacy and safety, and maintaining post-KT patient and graft survival. HCV elimination is highly feasible through multifaceted interventions, including mass screening, treatment scale-up, universal precautions, and post-SVR reinfection surveillance.
丙型肝炎病毒（HCV）感染是一个重大的健康问题，在慢性肾脏病（CKD）4 或 5 期患者中具有显著的临床和经济负担。目前的指南建议泛基因型直接作用抗病毒药物（DAA）作为 HCV 的一线治疗选择。这篇综述总结了有关 CKD 4 或 5 期患者（包括维持性透析患者）中 HCV 的流行病学、自然史、公共卫生观点以及泛基因型 DAA 在这些患者中的应用的最新知识。HCV 在 CKD 4 或 5 期患者中的流行率和发病率远高于普通人群。如果不进行治疗，无论是否进行肾移植（KT），HCV 患者的预后都会受到影响。在治疗诱导的 HCV 清除后，患者可以通过维持长期无病毒血症状态来改善与健康相关的结局。泛基因型 DAA 治疗 HCV 的持续病毒学应答（SVR）率和安全性无论 KT 情况如何都非常出色。在 CKD 各阶段均无需调整泛基因型 DAA 的剂量。在 HCV 治疗前评估药物相互作用（DDI）对于确保治疗期间的安全性至关重要。在接受 HCV 阳性供肾的 HCV 阴性受者中预防性或抢先使用泛基因型 DAA 已显示出缩短 KT 等待时间、实现优异的治疗效果和安全性以及维持术后患者和移植物存活率的潜力。通过多方面的干预措施，包括大规模筛查、治疗扩大、普遍预防和 SVR 后再感染监测，HCV 的消除是高度可行的。
