Update of hepatitis C therapy in patients with chronic kidney disease on hemodialysis
Abstract
Hepatitis C virus (HCV), causative agent of hepatitis C, was discovered 25 years ago. Most patients develop chronic HCV infection (55-85 %), which manifests with hepatic complications (cirrhosis, hepatocellular carcinoma) and extrahepatic ones. This virus is endemic in hemodialysis (HD) units, many patients being affected by its frequent outbreaks; although its prevalence has diminished, it is still three times higher than the one in the general population, and it continues to be a problem, especially for kidney transplantation patients with positive anti-HCV tests. In the last decade, the most important HCV infection treatment drugs were peginterferon and ribavirin; however, treatment was very complex due to some drugs toxicity (e.g. ribavirin), frequent adverse events and low virological and clinical response. The appearance of direct-acting antivirals (DAA) that cure more than 95 % of HCV infection cases has changed these patients' prognoses considerably and reduced the risk of death by liver cancer and cirrhosis. Access to diagnosis and treatment, on the other hand, is limited due to high costs. The aim of this study is to show nephrologists treating patients on HD the scenario brought about by the introduction of DAAs for HCV infection treatment and to discuss the dilemmas over the patients' treatment which needs to be solved.
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