An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease

Background: Hepatitis C virus infection remains common in patients with chronic kidney disease, including those on maintenance dialysis. The relationship between hepatitis C virus infection and chronic kidney disease is bi-directional; in fact, HCV is both a cause and consequence of chronic kidney d...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Fabrizio Fabrizi, Roberta Cerutti, Piergiorgio Messa
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	dialysis direct-acting antiviral agents Hepatitis C virus sustained viral response Medicine R
Acceso en línea:	https://doaj.org/article/c2faed92fb824559a1e6e699aa65e3b6
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:c2faed92fb824559a1e6e699aa65e3b6
record_format	dspace
spelling	oai:doaj.org-article:c2faed92fb824559a1e6e699aa65e3b62021-11-25T18:37:47ZAn Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease10.3390/pathogens101113812076-0817https://doaj.org/article/c2faed92fb824559a1e6e699aa65e3b62021-10-01T00:00:00Zhttps://www.mdpi.com/2076-0817/10/11/1381https://doaj.org/toc/2076-0817Background: Hepatitis C virus infection remains common in patients with chronic kidney disease, including those on maintenance dialysis. The relationship between hepatitis C virus infection and chronic kidney disease is bi-directional; in fact, HCV is both a cause and consequence of chronic kidney disease. According to a systematic review with meta-analysis of observational studies (<i>n</i> = 23 studies) (<i>n</i> = 574,081 patients on long-term dialysis), anti-HCV positive serologic status was an independent and significant risk factor for death in patients with advanced chronic kidney disease on long-term dialysis. The overall estimate for adjusted mortality (all-cause death risk) with HCV was 1.26 (95% CI, 1.18; 1.34) (<i>p </i>< 0.0001). Interferon-based therapies are biased by low efficacy/safety in chronic kidney disease, but the advent of direct-acting antiviral drugs has made a paradigm shift in the treatment of HCV-infection. These medications give interruption of viral replication because they target specific non-structural viral proteins; four classes of DAAs exist-NS3/4A protease inhibitors, NS5A inhibitors, NS5B nucleoside and non-nucleoside polymerase inhibitors. All-oral, interferon-free, ribavirin-free combinations of DAAs are now available. Aim: The goal of this narrative review is to report the available treatment options for HCV in advanced chronic kidney disease. Methods: We have made an extensive review of the medical literature and various research engines have been adopted. Results: Some combinations of DAAs are currently recommended for HCV in advanced CKD (including patients on maintenance dialysis): elbasvir/grazoprevir; glecaprevir/pibrentasvir; and sofosbuvir-based regimens. Solid evidence, based on registration and “real life” studies supports their efficacy (SVR rates > 90%) and safety even in patients with advanced CKD. No dosage adjustment is necessary and treatment duration is 8–12 weeks. However, recent data highlight that many patients with advanced CKD remain untreated, and numerous barriers to antiviral treatment of HCV still exist. Whether successful antiviral therapy with DAAs will translate into improved survival in the advanced CKD population is another point of future research.Fabrizio FabriziRoberta CeruttiPiergiorgio MessaMDPI AGarticledialysisdirect-acting antiviral agentsHepatitis C virussustained viral responseMedicineRENPathogens, Vol 10, Iss 1381, p 1381 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	dialysis direct-acting antiviral agents Hepatitis C virus sustained viral response Medicine R
spellingShingle	dialysis direct-acting antiviral agents Hepatitis C virus sustained viral response Medicine R Fabrizio Fabrizi Roberta Cerutti Piergiorgio Messa An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
description	Background: Hepatitis C virus infection remains common in patients with chronic kidney disease, including those on maintenance dialysis. The relationship between hepatitis C virus infection and chronic kidney disease is bi-directional; in fact, HCV is both a cause and consequence of chronic kidney disease. According to a systematic review with meta-analysis of observational studies (<i>n</i> = 23 studies) (<i>n</i> = 574,081 patients on long-term dialysis), anti-HCV positive serologic status was an independent and significant risk factor for death in patients with advanced chronic kidney disease on long-term dialysis. The overall estimate for adjusted mortality (all-cause death risk) with HCV was 1.26 (95% CI, 1.18; 1.34) (<i>p </i>< 0.0001). Interferon-based therapies are biased by low efficacy/safety in chronic kidney disease, but the advent of direct-acting antiviral drugs has made a paradigm shift in the treatment of HCV-infection. These medications give interruption of viral replication because they target specific non-structural viral proteins; four classes of DAAs exist-NS3/4A protease inhibitors, NS5A inhibitors, NS5B nucleoside and non-nucleoside polymerase inhibitors. All-oral, interferon-free, ribavirin-free combinations of DAAs are now available. Aim: The goal of this narrative review is to report the available treatment options for HCV in advanced chronic kidney disease. Methods: We have made an extensive review of the medical literature and various research engines have been adopted. Results: Some combinations of DAAs are currently recommended for HCV in advanced CKD (including patients on maintenance dialysis): elbasvir/grazoprevir; glecaprevir/pibrentasvir; and sofosbuvir-based regimens. Solid evidence, based on registration and “real life” studies supports their efficacy (SVR rates > 90%) and safety even in patients with advanced CKD. No dosage adjustment is necessary and treatment duration is 8–12 weeks. However, recent data highlight that many patients with advanced CKD remain untreated, and numerous barriers to antiviral treatment of HCV still exist. Whether successful antiviral therapy with DAAs will translate into improved survival in the advanced CKD population is another point of future research.
format	article
author	Fabrizio Fabrizi Roberta Cerutti Piergiorgio Messa
author_facet	Fabrizio Fabrizi Roberta Cerutti Piergiorgio Messa
author_sort	Fabrizio Fabrizi
title	An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
title_short	An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
title_full	An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
title_fullStr	An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
title_full_unstemmed	An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease
title_sort	updated view on the antiviral therapy of hepatitis c in chronic kidney disease
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c2faed92fb824559a1e6e699aa65e3b6
work_keys_str_mv	AT fabriziofabrizi anupdatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease AT robertacerutti anupdatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease AT piergiorgiomessa anupdatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease AT fabriziofabrizi updatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease AT robertacerutti updatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease AT piergiorgiomessa updatedviewontheantiviraltherapyofhepatitiscinchronickidneydisease
_version_	1718410918875889664

An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease

Ejemplares similares