Sofosbuvir Based Regimen in Management of Hepatitis C for Patients With End Stage Renal Disease on Hemodialysis: A Single Center Experience from India.

Background: Hepatitis C infection is known to increase the morbidity in patients with end stage renal disease (ESRD). Interferon based treatment is poorly tolerated and has limited cure rates in these patients. In limited available data, sofosbuvir based regimens have been shown to have favorable outcomes in these patients.

Methods: We treated 7 patients with ESRD on hemodialysis, 6 with chronic hepatitis C and one with acute hepatitis C. Two of them were cirrhotic of which one was decompensated. All patients were treated with sofosbuvir 200 mg with daclatasvir 60 mg or ribavirin 200 mg once daily. Patients with evidence of cirrhosis were treated for 24 weeks, others were treated for 12 weeks. HCV RNA quantitative PCR was monitored at weeks 2, 4, 12, end of therapy and after 12 weeks of end of treatment (SVR12).

Results: The study cohort included five males and two females, aged (48.4 ± 14.5 years). Four patients had genotype 1 and three had genotype 3. One patient was treated with sofosbuvir and ribavirin while others were treated with sofosbuvir and daclatasvir. One patient died of unrelated cause during the therapy. One patient who received sofosbuvir and daclatasvir, could not complete the therapy beyond 20 weeks because she developed recurrent hypoglycemia, which improved after stopping the therapy, all the other patients had SVR 12. There was no change in Hb levels or erythropoietin requirement in the patients receiving sofosbuvir and daclatasvir.

Conclusion: Our data suggest that sofosbuvir based therapy is effective in patients with ESRD and hepatitis C, including those with liver cirrhosis. Its use may be recommended especially in countries where other drugs are not available. Due to limited experience however, patients should be closely monitored for adverse effects. Hypoglycemia may be a potential adverse effect of sofosbuvir and daclatasvir therapy.