Elimination of hepatitis C virus infection in hemodialysis patients in the Republic of Srpska: Small Group

Background and aims: Hepatitis C virus (HCV) infection is common among patients on haemodialysis (HD) therapy and is an important cause of morbidity and mortality. In patients with chronic kidney disease (CKD), the risks for negative outcomes are significantly higher in HCV-infected patients than in those without HCV infection, including progression to cirrhosis, hepatocellular carcinoma and liver-related mortality. Micro-elimination of hepatitis C in renal patients is crucial. This study aims to assess the efficacy and safety of directly acting antivirals in chronic kidney disease patients and the effect of treatment on kidney functions. Methods: The course of treatment with antiviral therapy in patients on chronic hemodialysis program was analyzed. Pre-treatment evaluation of HCV infection included HCV RNA, genotype, and liver fibrosis assed by transient fibroelastography (FibroScan). The stage 5 CKD was defined as an eGFR of <15 mL/min/1.73 m2, respectively; those on haemodialysis were considered to have stage 5 CKD or end-stage renal disease (ESRD). Demographic data and concomitant medication were retrieved from patients’ records. The primary endpoint was sustained virologic response at post-treatment week 12 (SVR12). We collected data on on-treatment adverse events (AEs), serious AEs, and laboratory abnormalities. Results: From 2008 until now, a total of 25 patients were treated for chronic HCV infection on a chronic hemodialysis program with three therapeutic antiviral modalities. Treatment with pegylated interferon (PEG-IFN) alfa 2a with or without ribavirin (RBV) was performed in 16 patients. This treatment showed the least effectiveness and great intolerability. Seven patients were treated with a 3D regimen - Paritaprevir/Ritonavir/ Ombitasvir and Dasabuvir with or without Ribavirin. Among the 7 treated patients, 6 were male and 1 female, all were infected with genotype 1 (5 GT1b, 2 GT1a). The patient had compensated liver cirrhosis, and six patients did not have liver cirrhosis, none were transplanted. All seven patients completed 12 weeks of treatment and achieved SVR12. One patient had significant decreases in hemoglobin, white blood cell, and platelet counts during the treatment period. The most common adverse events were nausea, diarrhea. Adverse events were generally mild and no patient discontinued due to an AE. Two patients were treated with the pangenotypic drug glecaprevir/pibrentasvir, the shortest therapeutic regimen of 8 weeks, with excellent efficacy and safety. This was the most comfortable therapy regimen. Due to implementation of HCV infection control procedures within dialysis units and elimination of HCV from the bloodstream, the frequency of HCV infection is gradually decreasing in many dialysis centers. Conclusions: Treatment with OBV/PTV/r + DSV ± RBV and pangenotypic glecaprevir/ pibrentasvir was well tolerated and resulted in high SVR12 rates (100%) in hemodialysis patients. DAA treatment provided significant improvement in patients with HHC, compared to PEG-IFN/RBV in patients with ESRD.