Ratiu Ioana Adela, Mihaescu Adelina, Olariu Nicu, Ratiu Cristian Adrian, Cristian Bako Gabriel, Ratiu Anamaria, Indries Mirela, Fratila Simona, Dejeu Danut, Teusdea Alin, Ganea Mariana, Moisa Corina, Marc Luciana
Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania.
Nephrology Department, Emergency Clinical Hospital Bihor County, 12 Corneliu Coposu Street, 410469 Oradea, Romania.
Medicina (Kaunas). 2024 Dec 21;60(12):2093. doi: 10.3390/medicina60122093.
Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting antivirals (DAAs) on patient outcomes. Moreover, a narrative review aims to summarize the current knowledge regarding HCV treatment in HD patients. The search in the PubMed, Google Scholar, and Scopus databases identified 48 studies relevant to our topic, 18 regarding clinical history and 29 related to HCV treatment. : A retrospective analysis was performed on 165 HD patients from Bihor County HD centers, Romania, between 2014 and 2024. The cohort was divided into two groups: 54 patients who tested positive for HCV and 111 controls who were HCV-negative. Data collected from GPs included demographic information, comorbidities, laboratory parameters, and psychological assessments. Outcomes were evaluated at over 5 years after DAA treatment. A literature review was conducted using PubMed and Google Scholar to identify relevant studies on HCV in HD patients from 1989 to 2024. Laboratory results showed similar parameters across groups, except for lower serum cholesterol levels in the HCV-positive DAA-treated group vs. HCV-positive non-treated ones (155.607 mg% vs. 170.174 mg%, = 0.040) and increased ALT levels when comparing the same groups (29.107 vs. 22.261, = 0.027), whereas comorbidities did not differ significantly. The incidence of malignancies was significantly higher among HCV-positive compared to HCV-negative patients (20.3% vs. 8.1%, = 0.023), mainly among those treated with DAAs, highlighted by the multivariate analysis. Cardiovascular disease remains the leading cause of mortality regardless of HCV status or the use of antiviral therapy. Psychological assessments revealed more severe depression in HCV-positive patients compared to their HCV-negative counterparts. HCV infection in the hemodialysis population typically follows a subclinical course. At over five years after DAA therapy, the results indicate a stabilization of the liver function and the absence of major complications. However, the incidence of malignancies remains high in HCV-positive patients.
丙型肝炎病毒（HCV）感染是一个重大的全球公共卫生问题，在血液透析（HD）患者中尤为突出。本研究旨在评估接受HD治疗的HCV阳性患者的人口统计学、临床和实验室特征，并评估直接抗病毒药物（DAAs）对患者预后的长期影响。此外，一篇叙述性综述旨在总结目前关于HD患者HCV治疗的知识。在PubMed、谷歌学术和Scopus数据库中进行检索，确定了48项与我们主题相关的研究，其中18项关于临床病史，29项与HCV治疗相关。对罗马尼亚比霍尔县HD中心2014年至2024年间的165例HD患者进行了回顾性分析。该队列分为两组：54例HCV检测呈阳性的患者和111例HCV阴性的对照者。从全科医生收集的数据包括人口统计学信息、合并症、实验室参数和心理评估。在DAA治疗超过5年后评估预后。使用PubMed和谷歌学术进行文献综述，以确定1989年至2024年间关于HD患者HCV的相关研究。实验室结果显示，各组参数相似，但HCV阳性DAA治疗组的血清胆固醇水平低于HCV阳性未治疗组（155.607mg%对170.174mg%，P=0.040），且比较相同组时ALT水平升高（29.107对22.261，P=0.027），而合并症无显著差异。HCV阳性患者的恶性肿瘤发生率显著高于HCV阴性患者（20.3%对8.1%，P=0.023），多因素分析突出显示主要发生在接受DAA治疗的患者中。无论HCV状态或抗病毒治疗的使用情况如何，心血管疾病仍然是主要的死亡原因。心理评估显示，HCV阳性患者比HCV阴性患者的抑郁更严重。血液透析人群中的HCV感染通常呈亚临床过程。在DAA治疗超过五年后，结果表明肝功能稳定且无重大并发症。然而，HCV阳性患者的恶性肿瘤发生率仍然很高。
