2016 Volume 4 Issue 2 Pages 169-176
Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with hemodialysis (HD). It was reported the prevalence of anti-HCV seropositivity among patients on maintenance HD was 9.84％ at 2007 in Japan. Although the spread of HCV in HD units is declining, the prevalence of HCV in HD patients remains still high. The two major HCV-related complications are reported as liver-related (cirrhosis and hepatocellular carcinoma) and non-liver-related disorders (cardiovascular disease, and so on). These are suspected causes of higher mortality among HCV-positive patients, antiviral therapy is recommended for all HCV patients with HD. Infection with HCV leads to increased serum alanine aminotransferase (ALT) in patients without HD. However, this test has weak diagnostic value in HD patients because ALT tends to be below reference range in this patient group. Therefore, novel non-invasive techniques for assessing liver fibrosis in HD patients with HCV infection are proposed. Two of these are the aspartate aminotransferase toplatelet ratio index (APRI) and transient elastography (TE) which is performed with a FibroscanTM machine. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected HD patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30％ to 40％. However, remarkable adverse effects including flulike syndrome, fatigue/weakness, and loss of appetite require withdrawal of anti-viral treatment in many patients. Recently reported combination therapy with two oral direct-acting antiviral drugs, daclatasvir (DCV) and asunaprevir (ASV), both of which are metabolized in the liver and excreted into the bile ducts, showed a high rate of HCV eradication in HCV-infected patients with genotype 1B. We evaluated the 12-week SVR (SVR12) rate and adverse events during treatment. The safety and viral responses were compared among patients infected with HCV, between 28 patients receiving HD and propensity score-matched 56 patients without renal dysfunction. The rate of SVR12 was 100％ in patients receiving HD and 94.6％ in patients without renal dysfunction. No adverse constitutional events were observed in both of the groups. The elevation of serum alanine aminotransferase levels, a known adverse effect of these drugs, was observed in comparable rate of patients between the two groups. DCV and ASV combination therapy for chronic HD patients with HCV infection was highly effective and well tolerated with a comparable safety profile to patients without renal dysfunction.
