Accumulation of excessive fat in the liver is the common denominator underlying the two most common and emerging causes of chronic liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), that are emerging public health issues globally. The burden of both ALD and NAFLD are increasing worldwide (1,2). ALD occur as a component of a broader perspective of alcohol abuse disorders, is frequently associated with psychiatric comorbidities and is the most frequent cause of morbidity, health care utilization and mortality in alcohol use disorders (3)(4)(5)(6). This is in contrast to NAFLD that occurs as an essential component of metabolic disorders that are associated with insulin resistance as the pathophysiological hallmark and is clinically manifest as hepatic, pancreatic, cardiac endothelial cell dysfunction and disease. In NAFLD, death is most commonly due to cardiovascular disease and often nonhepatic cancers apart from liver disease (7,8). The current global march of NAFLD as a public health challenge parallels the global upsurge for food intake, increase in per capita income, sedentary lifestyle, increasing body mass index and finally is an expression of an excess of caloric
Multiple courses of G-CSF improved 12-month TFS, mobilized hematopoietic stem cells, improved disease severity scores, nutrition, fibrosis, QOL scores, ascites control, reduced infections, and the need for LT in patients with DC. However, the use of GH was not found to have any additional benefit. (Hepatology 2017).
Background & Aims
There is emerging data on the use of Sofosbuvir‐based directly acting antiviral (DAA) drug regimens in chronic hepatitis C (CHC) patients with end‐stage renal disease (ESRD) on maintenance haemodialysis (MHD). We evaluated the safety and efficacy of Sofosbuvir plus Velpatasvir fixed‐dose combination in CHC patients with ESRD on MHD.
Methods
Fifty‐one CHC patients with ESRD on MHD were included in a real‐life prospective study. All patients irrespective of genotype; presence of cirrhosis; treatment naive or experienced status were treated with full‐dose Sofosbuvir (400 mg) plus Velpatasvir (100 mg) fixed‐dosed combination given daily for 12 weeks. The efficacy was assessed by the sustained virological response (SVR12) with negative HCV RNA 12 weeks after the end of treatment (ETR). Side effects if any were recorded in all patients.
Results
The median HCV RNA level in 51 CHC patients [Males 41 (80.4%), mean age 42.8 ± 14.6 years] was 2.0 × 106 IU/mL. HCV genotype was available in 19 patients with predominant genotype 1 in 15 (79%) patients. Ten (19.6%) patients had evidence of cirrhosis (defined as LSM ≥ 12.5 kPa on Transient Elastography), and 8 (15.6%) patients were treatment experienced. Testing for ETR was done in 36 patients and all 36 (100%) patients achieved ETR, and 49 patients (96%) achieved SVR 12. All 51 patients tolerated the Sofosbuvir + Velpatasvir combination, with none of the patients reporting any serious adverse event.
Conclusion
Sofosbuvir plus Velpatasvir fixed‐dose combination is safe and effective in treating CHC in patients with ESRD on MHD.
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