Treatment of hepatitis C in patients with chronic kidney disease: a challenge
The prevalence of hepatitis C virus infection is several times higher in the sub-population of patients with chronic end -stage renal disease on dialysis, or transplanted. Therapy with Interferon and Ribavirin was for many years the gold standard treatment of hepatitis C. However, this therapy has many adverse effects and low effectiveness. The emergence of new drugs with direct antiviral action, has revolutionized the treatment of hepatitis C. Cure rates greater than 90% associated with easy and convenient oral administration and good safety profile, contributed to the large patient adherence to these therapies. Treatment options with Interferon-free and Interferon-Ribavirin-free regimens are now available. In chronic renal failure or dialysis patients, therapy with Interferon and Ribavirin is even worse tolerated. Initial studies with new drugs with direct antiviral action did not include patients with severe renal failure, and its use in these patients must be done carefully, since some drugs require dose adjusted to renal function. Preliminary results of ongoing studies are promising: Simeprevir, Ledipasvir and the combination Ritonavir-Paritaprevir-Ombitasvir-Dasabuvir seem to be safe and efficient in severe renal failure. Sofosbuvir is not indicated for patients with creatinine clearance < 30 ml/min/1.73m2 or on regular haemodialysis since no dose recommendation is defined. In kidney transplant patients, therapy with Interferon and Ribavirin is even more disappointing. The success rate is much lower than in the general population, and the toxicity is very high. Acute rejection and graft dysfunction rates greater than 20% are described even in the most recent series. There is a consensus that for these patients the ideal therapy should not include Interferon. However, until now there is no experience with the use of new drugs with direct antiviral action in kidney transplantation. Current recommendations suggest that the choice of therapy in these patients have regard to the function of the transplanted kidney and pharmacological interaction of new drugs with immunosuppressive therapy. Studies are needed to best define the most effective therapeutic and the optimal doses of these new drugs in the sub -population of patients with chronic renal disease
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| Format: | Digital revista |
| Language: | English |
| Published: |
Sociedade Portuguesa de Nefrologia
2015
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| Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692015000400005 |
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