Eradication of Hepatitis C in Renal Transplant Recipients With Sofosbuvir Based Direct Acting Antiviral Agents in Resources Sparse Country

Abstract

Introduction: Treatment of Hepatitis C is revolutionized but these novel agents are neither widely available nor recommended in renal transplant recipients (RTRs).We aimed to evaluate the effectiveness and safety of sofosbuvir (SOF) based regimen with or without daclatasavir (DAC) in RTRs; the only available agents in Pakistan. Methods: All RTRs receiving direct acting antiviral agents from August 2015 to 2018 were enrolled in the study. Patients' demographics and baseline laboratory parameters and virologic reponse were analyzed Results: A total of 85 recipients were enrolled with the mean age was 37.6 ±10 years and majority (79.5%) was men. Eighteen patients were treatment experienced to interferon before transplant. Genotype 1 and mix genotype was documented in 39.8 % and 11.4 %, respectively. Fifty three patients (80.3%) were prescribed SOF and RBV for 6 months and 13 (18.8%) received SOF, DAC and RBV combination for 3 months. At the time of study, 64 patients completed their treatment course. Rapid virologic response was achieved in 57 patients (89.1 %). End-of treatment response was achieved in 61 patients (95.3 %). At the time of writing, SVR 12 and 24 was achieved in 48 and 21 patients, respectively. Anemia was noted in 11 patients (17.8 %) requiring RBV dose modification. Ascites resolved in 2 patients after treatment Conclusion: Studies and case reports in RTRs have demonstrated the effectiveness of sofosbuvir-based regimens for HCV eradiation with no allograft rejection1-3. Kamar et al,2documented 100% SVR12 in 25 RTRs; 3 patients received SOF with RBV while other 3 were prescribed SOF with DAC combination. Xue Y et al,3 documented 100 % SVR 12 in 6 RTRs treated with 12 weeks of SOF and DAC combination. Here we report, successful eradication of HCV in RTRs using a combination of sofosbuvir with ribavirin and sofosbuvir, daclatasavir and ribavarin. This combination was effective and well tolerated in our study population even with mixed genotype (i.e., 1 and 3) with no major adverse events.