Introduction: Patients with chronic hepatitis C and end-stage renal disease (ESRD) have encountered negative conditions not only liver-related complications, but also increased extra-hepatic comorbidities. Using of efficient, well-tolerated and safe direct-acting antivirals (DAAs) is major step forward in the treatment of these patients. This study aimed both to carry out the efficacy and tolerability of DAAs in patients with ESRD and also to analyze early viral response in the preparation of patients for kidney transplantation.
Methods: We performed a prospective analysis of 15 patients with ESRD and HCV infection treated with ombitasvir-paritaprevir-ritonavir and dasabuvir combination with or without ribavirin based on genotype of HCV in our center.
Results: The patients were predominantly male (n=10) and median age was 52 years. Most patients (n=10) were infected with genotype 1b. None of the patients were cirrhotic. All patients were on chronic renal replacement therapy, one patient on peritoneal dialysis and others on hemodialysis. Ribavirin was added the treatment regimen in three patients infected with genotype 1a. HCV-RNA was negative at the fourth week of the treatment in all patients. Fourteen patients completed treatment and they achieved viral clearance at the end of the treatment. Sustained virologic response after 12 weeks was observed in 93.3% of the patients. Only one patient with previous history of coronary bypass graft died because of progressive heart failure and ventricular arrhythmia at the fourth week of antiviral treatment. Indeed, this patient showed early virologic response as well. There were no severe adverse effects or drug interactions. Two out of patients who received Ribavirin needed dose reduction and red blood cell transfusion.
Conclusion: Our study demonstrated once again that ombitasvir-paritaprevir-ritonavir and dasabuvir combination with or without ribavirin is well-tolerated, safe and efficient antiviral therapy in patients with ESRD and hepatitis C. From another perspective, high success in early virologic response provides early and uneventfully access to kidney transplantation.