Evaluation of Long-Term Outcomes of Direct Acting Antiviral Agents in Chronic Kidney Disease Subjects: A Single Center Cohort Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 May 27

PMID 37240622

Authors

Paulina Czarnecka

Kinga Czarnecka

Olga Tronina

Teresa Baczkowska

Aleksandra Wyczalkowska-Tomasik

Magdalena Durlik

Katarzyna Czerwinska

Affiliations

Soon will be listed here.

Abstract

Background: The chronic kidney disease (CKD) population, including kidney transplant recipients (KTRs) and subjects on renal replacement therapy, is particularly vulnerable to unfavorable outcomes from chronic hepatitis C (CHC). Currently, there are oral direct-acting antiviral agents (DAAs) available to eradicate the virus with favorable short-term outcomes; however, their long-term effects are lacking. The aim of the study is to assess the long-term efficacy and safety of DAA therapy in the CKD population.

Methods: An observational, cohort single-center study was performed. Fifty-nine CHC subjects with CKD, treated with DAAs between 2016 and 2018, were enrolled in the study. Safety and efficacy profiles were assessed, including sustained virologic response (SVR), occult hepatitis C infection (OCI) incidence, and liver fibrosis.

Results: SVR was achieved in 96% of cases (n = 57). OCI was diagnosed only in one subject following SVR. Significant liver stiffness regression was observed 4 years after SVR compared to baseline values (Mdn = 6.1 kPa, IQR = 3.75 kPa; 4.9 kPa, IQR = 2.9 kPa), < 0.001. The most common adverse events were anemia, weakness, and urinary tract infection.

Conclusion: DAAs provide a safe and effective cure for CHC in both CKD patients and KTRs with a favorable safety profile in the long-term follow-up.

Citing Articles

Chronic Hepatitis C Infection Treated with Direct-Acting Antiviral Agents and Occurrence/Recurrence of Hepatocellular Carcinoma: Does It Still Matter?.

Smirne C, Crobu M, Landi I, Vercellino N, Apostolo D, Pinato D Viruses. 2025; 16(12.

PMID: 39772206 PMC: 11680226. DOI: 10.3390/v16121899.

Renal Manifestations of Chronic Hepatitis C: A Review.

Sohal A, Singh C, Bhalla A, Kalsi H, Roytman M J Clin Med. 2024; 13(18).

PMID: 39337023 PMC: 11433393. DOI: 10.3390/jcm13185536.

Liver Stiffness Evaluation in Chronic Hepatitis C Patients with Cirrhosis before and after Direct-Acting Antivirals.

Stasi C, Brillanti S Microorganisms. 2024; 12(7).

PMID: 39065186 PMC: 11279336. DOI: 10.3390/microorganisms12071418.

Real-world effectiveness of genotype-specific and pangenotypic direct-acting antivirals in HCV-infected patients with renal failure.

Tronina O, Brzdek M, Zarebska-Michaluk D, Lorenc B, Janocha-Litwin J, Berak H Clin Exp Hepatol. 2024; 9(4):320-334.

PMID: 38774196 PMC: 11103803. DOI: 10.5114/ceh.2023.133307.

References

Roth D, Nelson D, Bruchfeld A, Liapakis A, Silva M, Monsour Jr H . Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet. 2015; 386(10003):1537-45. DOI: 10.1016/S0140-6736(15)00349-9. View

Fabrizi F, Messa P, Martin P . Health-related quality of life in dialysis patients with HCV infection. Int J Artif Organs. 2009; 32(8):473-81. DOI: 10.1177/039139880903200801. View

Liu C, Lee M, Lin J, Liu C, Su T, Tseng T . Evolution of eGFR in chronic HCV patients receiving sofosbuvir-based or sofosbuvir-free direct-acting antivirals. J Hepatol. 2019; 72(5):839-846. DOI: 10.1016/j.jhep.2019.11.014. View

Holmberg S, Lu M, Rupp L, Lamerato L, Moorman A, Vijayadeva V . Noninvasive serum fibrosis markers for screening and staging chronic hepatitis C virus patients in a large US cohort. Clin Infect Dis. 2013; 57(2):240-6. PMC: 5672918. DOI: 10.1093/cid/cit245. View

Li J, Gordon S, Rupp L, Zhang T, Boscarino J, Vijayadeva V . The validity of serum markers for fibrosis staging in chronic hepatitis B and C. J Viral Hepat. 2014; 21(12):930-7. DOI: 10.1111/jvh.12224. View

Flisiak R, Zarebska-Michaluk D, Janczewska E, Lapinski T, Rogalska M, Karpinska E . Five-Year Follow-Up of Cured HCV Patients under Real-World Interferon-Free Therapy. Cancers (Basel). 2021; 13(15). PMC: 8345092. DOI: 10.3390/cancers13153694. View

. KDIGO 2022 Clinical Practice Guideline FOR the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int. 2022; 102(6S):S129-S205. DOI: 10.1016/j.kint.2022.07.013. View

Hsu W, Lai H, Su W, Lin C, Chuang P, Chen S . Rapid decline of noninvasive fibrosis index values in patients with hepatitis C receiving treatment with direct-acting antiviral agents. BMC Gastroenterol. 2019; 19(1):63. PMC: 6486982. DOI: 10.1186/s12876-019-0973-5. View

Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M . Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005; 128(2):343-50. DOI: 10.1053/j.gastro.2004.11.018. View

10.

Gane E, Lawitz E, Pugatch D, Papatheodoridis G, Brau N, Brown A . Glecaprevir and Pibrentasvir in Patients with HCV and Severe Renal Impairment. N Engl J Med. 2017; 377(15):1448-1455. DOI: 10.1056/NEJMoa1704053. View

11.

Poggio E, Augustine J, Arrigain S, Brennan D, Schold J . Long-term kidney transplant graft survival-Making progress when most needed. Am J Transplant. 2020; 21(8):2824-2832. DOI: 10.1111/ajt.16463. View

12.

Potthoff A, Berg T, Wedemeyer H . Late hepatitis B virus relapse in patients co-infected with hepatitis B virus and hepatitis C virus after antiviral treatment with pegylated interferon-a2b and ribavirin. Scand J Gastroenterol. 2009; 44(12):1487-90. DOI: 10.3109/00365520903329585. View

13.

Castillo I, Bartolome J, Quiroga J, Barril G, Carreno V . Diagnosis of occult hepatitis C without the need for a liver biopsy. J Med Virol. 2010; 82(9):1554-9. DOI: 10.1002/jmv.21866. View

14.

Pol S, Parlati L, Jadoul M . Hepatitis C virus and the kidney. Nat Rev Nephrol. 2018; 15(2):73-86. DOI: 10.1038/s41581-018-0081-8. View

15.

. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017; 2(3):161-176. DOI: 10.1016/S2468-1253(16)30181-9. View

16.

Waziry R, Hajarizadeh B, Grebely J, Amin J, Law M, Danta M . Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression. J Hepatol. 2017; 67(6):1204-1212. DOI: 10.1016/j.jhep.2017.07.025. View

17.

. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018; 69(2):461-511. DOI: 10.1016/j.jhep.2018.03.026. View

18.

Sawinski D, Kaur N, Ajeti A, Trofe-Clark J, Lim M, Bleicher M . Successful Treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents. Am J Transplant. 2015; 16(5):1588-95. DOI: 10.1111/ajt.13620. View

19.

Pardo M, Lopez-Alcorocho J, Rodriguez-Inigo E, Castillo I, Carreno V . Comparative study between occult hepatitis C virus infection and chronic hepatitis C. J Viral Hepat. 2007; 14(1):36-40. DOI: 10.1111/j.1365-2893.2006.00783.x. View

20.

Piedade J, Pereira G, Guimaraes L, Duarte J, Victor L, Baldin C . Liver stiffness regression after sustained virological response by direct-acting antivirals reduces the risk of outcomes. Sci Rep. 2021; 11(1):11681. PMC: 8175552. DOI: 10.1038/s41598-021-91099-1. View