Hepatitis C Treatment in Peritoneal Dialysis Patients: A Report of Two Cases

Abstract

Treatment of patients with hepatitis C as well as concomitant kidney dysfunction has long presented a challenge. The new direct acting antivirals (DAAs) show promise for patients who have advanced and end-stage renal disease. While recent evidence suggests that certain DAA regimens have proven successful in patients with end-stage renal disease on hemodialysis, a paucity of data exists on the treatment of hepatitis C in end-stage renal disease patients on peritoneal dialysis. We present two cases of patients undergoing peritoneal dialysis who were treated successfully with different antiviral regimens. The first patient is a 36-year-old male with a history of cirrhosis secondary to hepatitis C as well as end-stage renal disease secondary to hypertension for which he was on peritoneal dialysis. He was treated with sofosbuvir and simeprevir for twelve weeks. He did demonstrate sustained virologic response after his twelve-week treatment course with no adverse reactions. The second case is a 66-year-old female with a history of hepatitis C and end stage renal disease on peritoneal dialysis. She was initially treated with a 48-week-course of peginterferon-alpha-2a and weight-based ribavirin but experienced relapse 6 months after treatment. Three years later she was treated with a 24-week-course of ledipasvir and sofosbuvir. She tolerated the treatment well and she too demonstrated a sustained virologic response. The treatment of hepatitis C in patients with late- and endstage renal disease has made great advances in the past several years. In the past, these patients had been relegated to treatment with interferon or pegylated interferon alpha, often as a monotherapy or in conjunction with low-dose ribavirin. These treatments are rigorous with a prolonged treatment course, significant side effects, and high rates of relapse, with recurrence of disease as high as 60 percent. The advent of second generation DAAs has shown promise in patients with advanced and end-stage kidney disease. There is a dearth of literature on the treatment of patients with hepatitis C on peritoneal dialysis with the second generation DAAs. Our case studies suggest that treatment in the peritoneal dialysis population is likely equally efficacious and well-tolerated and should be considered in this patient population.