Recent Advances on Hepatitis C Virus in Dialysis Population

Fabrizi, Fabrizio; Martin, Paul

doi:10.1159/000355803

Cited by 24 publications

(26 citation statements)

References 51 publications

(66 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Recent studies suggest that HCV-infected patients with CKD have an accelerated rate of kidney function loss and an increased risk of progressing to ESRD. [14][15][16][17][18][19] In one study, Molnar et al 19 showed that HCVinfected patients with CKD had an increased mortality and an accelerated rate of progression to ESRD, raising the important question of whether treating to obtain a sustained virologic response defined as an undetectable viral load 12 weeks after completion of treatment (SVR12) would diminish the rate of decline in GFR.…”

Section: Hcv In Patients With Kidney Diseasementioning

confidence: 99%

Hepatitis C Virus Infection in Chronic Kidney Disease

Ladino

Pedraza

Roth

2016

JASN

View full text Add to dashboard Cite

Soon after the hepatitis C virus (HCV) was identified in 1989, it was recognized that the prevalence of infection in patients with ESRD far exceeded that in the general population. Infection with HCV predisposes to the hepatic complications of cirrhosis and hepatocellular carcinoma. However, important extrahepatic manifestations include immune complex glomerular disease, accelerated progression of CKD, increases in cardiovascular event risk, and lymphoproliferative disorders. Advances in understanding the molecular biology of HCV have ushered in a new era in the treatment of this infection. Second generation direct-acting antiviral agents have revolutionized therapy, with sustained virologic response rates (undetectable viral load 12 weeks after completing therapy) of .90% in most patients. Studies using direct-acting antivirals in patients with CKD and those on dialysis are showing excellent safety and efficacy as well. In this context, it is imperative that nephrologists become familiar with this literature, reviewed here, so that the important decisions, including which patients should be treated and the optimal timing to initiate therapy, are vetted in association with the compounding issues of CKD, ESRD, and kidney transplantation.

show abstract

Section: Hcv In Patients With Kidney Diseasementioning

confidence: 99%

Hepatitis C Virus Infection in Chronic Kidney Disease

Ladino

Pedraza

Roth

2016

JASN

View full text Add to dashboard Cite

show abstract

“…1 In developed countries, approximately 1.8% to 8% of the kidney transplant recipients are infected with HCV. 2,3 Hepatitis C virus infection has negative effects on both patient and graft survival.…”

Section: Introductionmentioning

confidence: 99%

“…14,22 The most frequent extrahepatic complications are de novo or recurrent glomerular disease and new-onset diabetes mellitus. 1 Hepatitis C virus-related liver disease after kidney transplant The risk of developing posttransplant liver disease depends on the severity of the liver disease before transplant, liver pathology, coinfection with hepatitis B virus, and the immunosuppressive regimen. 9 Immunosuppression could promote viral replication in hepatocytes, enhancing the progression of liver disease.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

Exp Clin Transplant

View full text Add to dashboard Cite

Hepatitis C virus infection is highly prevalent among kidney transplant recipients, occurring consequently to their previous treatment with hemodialysis. Hepatitis C virus infection has been associated with lower graft and patient survival compared with that shown in patients without infection. The lower survival has been associated with the posttransplant progression of liver disease and increased risk for development of extrahepatic complications. The choice of immunosuppressive drugs could significantly affect the course of the infection with an accelerated viral replication after kidney transplant. Eradicating hepatitis C virus infection with antiviral treatment is imperative to increasing graft and patient survival after transplant. Antiviral treatment options include standard interferon-based therapy and new directacting antiviral agents. Interferon-based treatment is rarely used in kidney transplant recipients because it has been associated with high risk of interferoninduced acute graft rejection. Several novel studies have shown that the new direct-acting antiviral agents are highly efficacious for treatment of hepatitis C infection in kidney transplant patients. Key words: Antiviral agents, Immunosuppression, Renal transplantation IntroductionHepatitis C virus (HCV) infection is relatively common among patients on hemodialysis and in kidney transplant recipients. 1 In developed countries, approximately 1.8% to 8% of the kidney transplant recipients are infected with HCV. 2,3 Hepatitis C virus infection has negative effects on both patient and graft survival. 2,4,5 A meta-analysis demonstrated that the presence of HCV antibodies was an independent and significant risk factor for death (risk ratio = 1.79; 95% confidence interval [CI], 1.57-2.03; P = .042) and graft failure (risk ratio = 1.56; 95% CI, 1.35-1.80; P = .019) after kidney transplant. 6 The lower survival was related to the posttransplant progression of liver disease induced by the use of immunosuppressive regimens 7,8 and increased risk for development of extrahepatic complications of HCV infection, including posttransplant de novo or recurrent glomerular disease and new-onset diabetes mellitus. 9,10 However, despite these risks, renal transplant is still recommended in HCV-positive patients, as survival is significantly better in those who undergo transplant versus infected patients who remain on hemodialysis. 11,12 Immunosuppressive drugs and hepatitis C virus infection The natural course of HCV infection in kidney transplant patients is more complex than in nontransplant patients. The use of immunosuppressive drugs could promote viral replication in hepatocytes and enhance the progression of liver disease or lead to reactivation of the HCV infection, which presents as acute hepatitis. [13][14][15] Controversy remains regarding what is the optimal immunosuppressive regimen for kidney transplant recipients with HCV infection. The use of induction therapy is not contraindicated in HCV-positive kidney transplant recipients. 16 Corticos...

show abstract

“…Of note, stratified analysis showed that the adjusted relative risk (aRR) for cardiovascular mortality with anti-HCV was 1.26 (95% CI, 1.10; 1.45) [6]. Studies are in progress to deepen our understanding of the link between HCV and cardiovascular risk among patients on maintenance dialysis [7].…”

Section: Introductionmentioning

confidence: 99%

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Espinosa

Hernández

Arenas

et al. 2015

Kidney Blood Press Res

Self Cite

View full text Add to dashboard Cite

Background/Aims: Hepatitis C virus infection remains prevalent among patients undergoing long-term haemodialysis and has a detrimental impact on survival in this population. Antiviral therapy for chronic hepatitis C in haemodialysis patients is still a challenge to clinicians. The aim of the current study is to evaluate the efficacy and safety of therapy with pegylated interferon, alone or combined with ribavirin, for chronic hepatitis C among patients undergoing long-term hemodialysis. Methods: We conducted a retrospective, multicenter cohort trial with monotherapy (pegylated interferon) (n=21) or combined antiviral therapy (pegylated interferon plus ribavirin) (n=5) for chronic hepatitis C in patients undergoing long-term haemodialysis. Results: Sustained virological response was obtained in eleven (42%) patients. Seven (26.9%) patients interrupted prematurely the antiviral treatment due to serious side-effects, the most frequent cause of treatment withdrawal being hematological (n=3). HCV RNA load was lower in responder than non-responder patients, 5.44 (3.45; 6.36) vs. 5.86 (4.61; 6.46) log₁₀ copies/mL, even if the difference was not significant (P=0.099). Blood transfusion requirement was greater in patients on combined antiviral therapy than those on pegylated interferon alone, 100% (5/5) vs. 0% (0/21), P=0.0001. No difference in sustained viral response occurred between patients on combined antiviral therapy and those on pegylated interferon monotherapy [40% (2/5) vs. 42.8% (9/21), P=0.90]. Conclusions: Results from this study showed that pegylated interferon alone or with ribavirin is unsatisfactory in terms of efficacy and safety. Prospective trials based on interferon-free regimens (i.e., sofosbuvir plus ribavirin or sofosbuvir plus daclatasvir) are under way in patients with hepatitis C receiving long-term hemodialysis.

show abstract

Recent Advances on Hepatitis C Virus in Dialysis Population

Cited by 24 publications

References 51 publications

Hepatitis C Virus Infection in Chronic Kidney Disease

Hepatitis C Virus Infection in Chronic Kidney Disease

Untitled

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Contact Info

Product

Resources

About