Direct-acting Antivirals for the Treatment of Kidney Transplant Patients With Chronic Hepatitis C Virus Infection in Spain: A Long-term Prospective Observational Study

A Study on the Prevalence of HCV Genotypes and the Effect of Direct-Acting Antiviral Therapy on Clinical and Laboratory Parameters in HCV-Infected Patients at a Tertiary Care Center in North India

Background

The purpose of this study was to investigate the prevalence and distribution of different HCV genotypes, as well as to evaluate clinical and laboratory parameters in HCV-infected patients before and after DAA treatment.

Material and Methods

An open-label prospective study was conducted on 50 HCV-infected individuals. The HCV-infected patients underwent a baseline evaluation with complete history, examination, and other clinical investigations. These patients received the appropriate DAA according to the genotype for 3 months. At the end of 3 months, these patients were again evaluated clinically.

Results

The majority of instances were among younger age groups. Genotype 3 (66%) was the most common. There was a statistically significant difference found in clinical parameters regarding total bilirubin (p=0.008), SGOT (p=0.001), SGPT (p=0.035), ALP (p=<0.001) and Blood Urea Nitrogen (p = 0.004). When 1a vs 1b intragroup comparison was drawn, there was a significant mean difference found in SGOT (p value= 0.053) and Creatinine (p=0.050) parameters while rest shows no significant difference when associated. In the comparison of 1a vs 3 or 4, none of the parameters shows significant difference while; when 1b vs 3 or 4 comparison was laid out, SGOT and Creatinine was found near to significant.

Conclusion

This study concludes that with the availability of DAAs, highly effective, short-duration, and safe regimens have created better outcomes for patients with HCV infection, especially in those groups where SVR was low with prior therapies or in those where IFN-based treatment strategies were contraindicated.

Breakthroughs and challenges in the management of pediatric viral hepatitis

Chronic infections by hepatitis B virus (HBV) and hepatitis C virus (HCV) major causes of advanced liver disease and mortality worldwide. Although regarded as benign infections in children, their persistence through adulthood is undoubtedly of concern. Recent advances in HCV treatment have restored the visibility of these conditions and raised expectations for HBV treatment, which is currently far from being curative. Herein we describe direct-acting antivirals available for pediatric HCV (sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) and their real-world use. A critical review of the HBV pediatric classification is provided. Anti-HBV investigational compounds are reviewed in light of the pathophysiology in the pediatric population, including capsid assembly modulators, antigen secretion inhibitors, silencing RNAs, and immune modifiers. Recommendations for screening and management of immunosuppressed children or those with other risk factors or comorbidities are also summarized.

Eradication of hepatitis C virus infection in kidney transplant recipients using direct-acting antiviral therapy: Qatar experience

Introduction

Hepatitis C virus (HCV) infection has detrimental effects on patient and graft survival after kidney transplantation. In the pre‐direct‐acting antiviral (DAA) era, treatment of HCV infection was associated with low response rates, poor tolerance, and increased risk of allograft rejection. However, DAAs have revolutionized HCV treatment. The aims of this study were to determine the impact of DAA on the sustained virologic response (SVR), renal function, and calcineurin inhibitor (CNI) levels and assess the tolerability to treatment in kidney transplant recipients with HCV infection in Qatar.

Methods

This retrospective study included the medical records of all kidney transplant recipients with confirmed HCV infection before January 1, 2020. All data were obtained from the patients’ electronic medical records; these included patient demographics; virologic responses to treatment; serum creatinine levels during treatment; urine protein to creatinine ratios and CNI levels before, during, and after treatment; and side effects related to DAA therapy.

Results

A total of 27 kidney transplant recipients with HCV were identified, 23 of whom received DAA therapy. The length of treatment ranged from 12 to 24 weeks, and 52% of patients had HCV genotype 1 infection. The median log10 HCV RNA was 6.6 copies per milliliter. None of the patients had liver cirrhosis, and all of them achieved SVR. There was no statistically significant difference in the glomerular filtration rate before, during, and after treatment. Most patients had stable CNI trough levels during treatment and did not require dose adjustment.

Conclusions

HCV infection was successfully eradicated by DAA therapy in kidney transplant recipients, with a 100% SVR rate. Moreover, DAA therapy was well‐tolerated, and kidney function remained stable without an increased risk of rejection. These results are expected to drive the eradication of hepatitis C from the entire country.