Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.88
Peer-review started: November 9, 2015
First decision: December 18, 2015
Revised: January 12, 2016
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: March 16, 2016
The standard antiviral therapy for dialysis patients infected with hepatitis C virus (HCV) is (pegylated) interferon monotherapy, but its efficacy is insufficient. Oral direct-acting antiviral agents (DAAs) have recently been developed for chronic hepatitis C patients. However, some DAAs have contraindications for chronic renal failure (CRF). Daclatasvir and asunaprevir are metabolized largely in the liver and are not contraindicated in CRF. Combination therapy with daclatasvir and asunaprevir was used for 4 dialysis patients infected with genotype 1b HCV. One patient had viral breakthrough, and the 3 others had sustained virological response 12. One patient was admitted for heart failure and percutaneous coronary intervention due to concomitant ischemic disease. Heart failure was unlikely to be caused by the combination therapy, as it was probably due to water overload. The patient continued to receive the combination therapy after the remission of the heart failure. The combination therapy was well tolerated in the other patients.
Core tip: Oral combination therapy with the direct-acting antiviral agents daclatasvir and asunaprevir, which are both metabolized largely in the liver, is a very useful strategy for dialysis patients infected with genotype 1b hepatitis C virus. Although there were only 4 dialysis patients, the combination therapy was effective and showed a relatively favorable safety profile. One patient was admitted for heart failure with or without pneumonitis and percutaneous coronary intervention, although the causal relationship between these adverse events and the combination therapy was interpreted as negative. Our case reports warrant further studies, although careful observation during the treatment is needed.