title: Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients.
abstract: Hepatitis C virus (HCV) infection is highly prevalent among patients on haemodialysis and leads to a poorer prognosis compared to patients who do not have said infection. Treatment with interferon and ribavirin is poorly tolerated and there are limited data on the experience with new direct-acting antivirals (DAAs). The aim of this study is to retrospectively analyse the current prevalence of HCV infection and efficacy and safety results with different DAA regimens in the haemodialysis population of 2hospital areas. This is a multicentre, retrospective and observational study in which HCV antibodies were analysed in 465 patients, with positive antibody findings in 54 of them (11.6%). Among these, 29 cases (53.7%) with genotypes 1 and 4 were treated with different DAA regimens, including combinations of paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir and ledipasvir, with/without ribavirin. Mean age was 53.3±7.9 years, 72.4% of patients were male and the most important aetiology of chronic kidney disease involved glomerular abnormalities. In 100% of cases, a sustained viral response was achieved after 24 weeks, regardless of DAA regimen received. Adverse effects were not relevant and no case required stopping treatment. In 15 cases, ribavirin was combined with the DAA. In these cases, the most significant adverse effect was anaemic tendency, which was reflected in the increase of the dose of erythropoietin stimulating agents, although none required transfusions. In summary, we conclude that new DAAs for the treatment of HCV in haemodialysis patients are highly effective with minimal adverse effects; it is a very important advance in HCV management. These patients are therefore expected to have a much better prognosis than they have had until very recently.
authors.affiliation: Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Soraya
authors.initials: S
authors.lastname: Abad
authors.affiliation: Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Almudena
authors.initials: A
authors.lastname: Vega
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.affiliation: Servicio de Nefrología. Hospital 12 de Octubre, Madrid, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hernández
authors.affiliation: Servicio de Nefrología. Hospital 12 de Octubre, Madrid, España.
authors.forename: Evangelina
authors.initials: E
authors.lastname: Mérida
authors.affiliation: Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Macías
authors.affiliation: Servicio de Medicina del Aparato Digestivo, Hospital 12 de Octubre, Madrid, España.
authors.forename: Raquel
authors.initials: R
authors.lastname: Muñoz
authors.affiliation: Servicio de Nefrología. Hospital 12 de Octubre, Madrid, España.
authors.forename: Mónica
authors.initials: M
authors.lastname: Milla
authors.affiliation: Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Jose
authors.initials: J
authors.lastname: Luño
authors.affiliation: Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España. Electronic address: juanmlopez@senefro.org.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: López-Gómez
mesh_terms: D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Antivirales de acción directa; Direct-acting antivirals; HCV infection; Haemodialysis; Hemodiálisis; Infección por el VHC