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World J Hepatol. Feb 8, 2017; 9(4): 180-190
Published online Feb 8, 2017. doi: 10.4254/wjh.v9.i4.180
Interferon-free regimens in patients with hepatitis C infection and renal dysfunction or kidney transplantation
Evangelos Cholongitas, Chrysoula Pipili, George V Papatheodoridis
Evangelos Cholongitas, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
Chrysoula Pipili, Division of Nephrology, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
George V Papatheodoridis, Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
Author contributions: Cholongitas E and Pipili C performed the literature search, wrote the first draft of the manuscript and approved the final version; Papatheodoridis GV wrote and edited the final draft of the manuscript and approved the final version.
Conflict-of-interest statement: Cholongitas E: Advisor/consultant/sponsored lectures for Abbvie, Astellas, Bristol-Myers Squibb, Gilead, Merck Sharp and Dohme, Novartis; Pipili C: None; Papatheodoridis GV: Grant/research support from Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Roche; advisor/consultant for Abbvie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKleine, Janssen, Merck Sharp and Dohme, Novartis, Roche; sponsored lectures for Abbvie, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Janssen, Merck Sharp and Dohme, Novartis, Roche; Data Safety Management Board for Gilead.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evangelos Cholongitas, Assistant Professor of Internal Medicine, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 49, Konstantinopoleos Street, 54642 Thessaloniki, Greece. cholongitas@yahoo.gr
Telephone: +30-23-10892110 Fax: +30-23-10855566
Received: September 14, 2016
Peer-review started: September 18, 2016
First decision: October 21, 2016
Revised: November 21, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 8, 2017
Processing time: 145 Days and 7 Hours
Abstract

Treatment of patients with chronic kidney disease (CKD) and chronic hepatitis C (CHC) differs from that used in the general CHC population mostly when glomerular filtration rate (GFR) is below 30 mL/min, as sofosbuvir, the backbone of several current regimens, is officially contraindicated. Given that ribavirin free regimens are preferable in CKD, elbasvir/grazoprevir is offered in CHC patients with genotype 1 or 4 and ombitasvir/paritaprevir and dasabuvir in genotype 1b for 12 wk. Although regimens containing peginterferon with or without ribavirin are officially recommended for patients with CKD and genotype 2, 3, 5, 6, such regimens are rarely used because of their low efficacy and the poor safety and tolerance profile. In this setting, especially in the presence of advanced liver disease, sofosbuvir-based regimens are often used, despite sofosbuvir contraindication. It seems to have good overall safety with only 6% or 3.4% of CKD patients to discontinue therapy or develop serious adverse events without drug discontinuation. In addition, sustained virological response (SVR) rates with sofosbuvir based regimens in CKD patients appear to be comparable with SVR rates in patients with normal renal function. Treatment recommendations for kidney transplant recipients are the same with those for patients with CHC, taking into consideration potential drug-drug interactions and baseline GFR before treatment initiation. This review summarizes recent data on the current management of CHC in CKD patients highlighting their strengths and weaknesses and determining their usefulness in clinical practice.

Keywords: Chronic hepatitis C virus infection; Kidney; Renal; Kidney transplantation; Direct acting antiviral agents; Glomerular filtration rate; Hepatitis C

Core tip: Recent evidence showed very good safety and efficacy of both interferon and ribavirin-free direct acting antivirals (DAAs) regimens in patients with severe kidney disease (CKD) or kidney transplantation. Nevertheless, sofosbuvir, the backbone of most antiviral schemes is officially contraindicated in patients with CKD (creatinine clearance < 30 mL/min). Accordingly, CKD patients with genotype 1 or 4 can be currently treated with available ribavirin free DAAs regimens without sofosbuvir, while those with non-1, non-4 genotype can officially be treated with peginterferon with or without ribavirin, but they are actually treated with sofosbuvir-based regimens mostly if they have advanced liver disease.