Hepatitis C infection and chronic kidney disease among Hispanics/Latinos

Abstract

Viral infections, including hepatitis C, can cause secondary glomerular nephropathies. Studies suggest that hepatitis C virus infection (HCV+) is a risk factor for chronic kidney disease (CKD) but evidence of this relationship is lacking among Hispanics/Latinos. We examined the association between HCV+ and incident CKD in a prospective cohort of Hispanics/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos. HCV+ was defined by detectable HCV antibodies with additional confirmation through HCV RNA or recombinant immunoblot assay testing. Incident CKD was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 or sex-specific threshold for albuminuria measured during follow-up. We used Poisson regression to estimate incidence rate ratios (IRR) of CKD and changes in eGFR- or albuminuria-based risk stages, separately. We used linear regression to estimate associations with continuous, annualized changes in eGFR and albuminuria. Over a follow-up period of 5.9 years, 712 incident CKD events occurred among 10,430 participants. After adjustment for demographic characteristics and comorbidities, HCV+ was not associated with incident CKD, defined by eGFR and albuminuria thresholds (IRR 1.29, 95% Confidence Interval 0.61, 2.73). HCV+ was significantly associated with higher eGFR risk stages (IRR 2.39, 95% CI 1.47, 3.61) with most participants transitioning from stage G1 to G2. HCV+ was associated with a continuous, annualized eGFR decline of −0.69 mL/min/m 2 /year (95% CI −1.23, −0.16). This large, cohort study did not find evidence of a strong association between HCV+ and new-onset CKD among Hispanics/Latinos. HCV infection may not be associated with risk of CKD among Hispanics/Latinos, although treatment with direct-acting antivirals is recommended for all HCV+ individuals, including those with established CKD or end-stage kidney disease.

La importancia de la monitorización de la función renal para el uso de Antivirales de Acción Directa en pacientes coinfectados por VIH/VHC

“…Recientemente hemos leído un artículo publicado en su renombrada revista; titulada "Primer reporte en Perú sobre terapia con antivirales de acción directa para hepatitis C crónica en pacientes VIH-positivos" elaborado por Jaime Antonio Collins Camones, Elena Rocío Chamorro Chirinos, Fiorella Vanessa Loyola Salvatierra; donde señalan la prescripción de Antivirales de Acción Directa (AAD) como terapia efectiva y segura en pacientes coinfectados con VIH/VHC, utilizando como parámetros de selección: edad, sexo, recuento de linfocitos T-CD4+ y carga viral del VIH de los últimos seis meses, TARV, marcadores de infección por virus de hepatitis B (VHB) y carga viral de este si hubo exposición al virus, serología para HTLV1, última carga viral detectable del virus de hepatitis C (VHC) y puntaje de fibrosis hepática -FIB-4 (1) . Sin embargo, los autores no toman en consideración la función renal en estos pacientes, a pesar de que el VHC en estado crónico se relaciona con el inicio de la Enfermedad Renal Crónica (ERC) (2) ; asimismo, una revisión sistemática evidenció que existe un aumento del riesgo de proteinuria y ERC en un 51% y 43% respectivamente (3) . Otro estudio realizado en pacientes VIH/VHC con mayor tamaño poblacional, demuestra que posiblemente una baja TFG (<60ml/min/1,73m 2 ) pueda limitar la administración de AAD (4) .…”