ISN-KDIGO Webinar: Hepatitis C Guideline Update
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Hepatitis C Virus (HCV) infection had been difficult to treat in patients with chronic kidney disease (CKD) due to toxicity and limited efficacy prior to introduction of direct acting antiviral (DAA) agents. However, although introduction of the initial DAA regimens was a major advance concern about efficacy and tolerability remained. This included tolerability of sofosbuvir in patients with more advanced chronic kidney disease. However more recent data has confirmed its safety in patients with advanced CKD. Introduction of pan genotypic DAA regimens now allows successful HCV therapy irrespective of viral genotype helping to reduce the complexity of treatment algorithms. DAA therapy has also facilitated expansion of kidney transplant donor pool by allowing use of organs from HCV positive individuals in HCV infected as well as HCV naïve. DAA therapy started shortly after kidney transplant prevents transmission of HCV to uninfected recipients. In already infected recipients DAA therapy aborts progression of HCV associated liver disease. Even in HCV infected patients with cirrhosis in the absent of decompensation DAA therapy allows isolated kidney transplant by preventing further progression of liver disease. DAA therapy has also improved management of immune mediated glomerulonephritis as it can be successfully treated obviating the need for renal biopsy in many patients.