Efficacy of Direct-Acting Antivirals for Hepatitis C Virus in Patients with Severe Renal Impairment: A Systematic Review

Abstract

Introduction: Treating Hepatitis C virus (HCV) in patients with severe chronic kidney disease (CKD) or end-stage renal disease (ESRD) has historically been challenging. The advent of pangenotypic direct-acting antivirals (DAAs) has changed the landscape. This review assesses their efficacy and safety in this population.

Methods: A systematic review was conducted of prospective studies and RCTs evaluating the efficacy of DAA regimens in patients with HCV and an eGFR <30 mL/min, including those on dialysis. The primary outcome was sustained virologic response (SVR).

Results: The review included 20 studies. Pangenotypic DAA regimens (e.g., glecaprevir/pibrentasvir, sofosbuvir/velpatasvir) achieved SVR rates of 95-100% in this difficult-to-treat population. The regimens were well-tolerated, with safety profiles comparable to those observed in patients without severe renal impairment.

Discussion: DAAs have revolutionized HCV treatment, making viral eradication achievable and safe for nearly all patients, including those with severe CKD and ESRD. This has major implications for managing HCV in the dialysis population and in kidney transplant candidates.

Conclusion: Direct-acting antiviral regimens are highly effective and safe for treating Hepatitis C infection in patients with severe renal impairment.