Abstract
In addition to liver disease, the hepatitis C virus (HCV) has been associated with autoimmune phenomena, such as mixed cryoglobulin and glomerulonephritis (GN). Until recently, both chronic hepatitis and HCV extra-hepatic manifestations were treated with peg-interferon plus ribavirin, however these drugs presented low efficacy and induced severe side effects. Nowadays, the HCV chronic hepatitis has been treated with direct acting antivirals (DAA), but studies on the DAA therapy for HCV-associated glomerulonephritis are scarce. Here, we describe two cases of HCV-associated glomerulonephritis that were treated with DAAs. In these two cases, previously experienced to peg-interferon plus ribavirin, the sofosbuvir plus simeprevir therapy was effective, without significant side effects, and interrupted the evolution of at least 20 years of both hepatic and renal diseases. These cases join the seven previously described cases that were treated with this DAAs association.
Highlights
Hepatitis C virus (HCV) infection affects approximately 71 million people, accounting for 400,000 deaths per year worldwide[1]
In addition to liver disease, this virus has been associated with autoimmune phenomena, involving cryoglobulinemia, linfoproliferative disorders, and glomerulonephritis[2,3]
This study aimed to describe the treatment of two patients with chronic HCV infection associated to cryoglobulinemia and glomerulopathy, who were treated with the new direct acting antivirals (DAA) SOF plus simeprevir (SIM) and achieved sustained virologic response (SVR)
Summary
Hepatitis C virus (HCV) infection affects approximately 71 million people, accounting for 400,000 deaths per year worldwide[1]. HCV infection causes high morbimortality, leading to liver cirrhosis and hepatocellular carcinoma in 4 to 20% of those infected[1,2]. In addition to liver disease, this virus has been associated with autoimmune phenomena, involving cryoglobulinemia, linfoproliferative disorders, and glomerulonephritis[2,3]. HCV patients with glomerulopathies, in particular membranoproliferative glomerulonephritis (MPGN), were treated with interferon (IFN) or peg-interferon (PEG-IFN) associated with ribavarin (RBV), but this therapy induced serious side effects and low sustained virologic response (SVR), often less than 50%3,4. The new direct-acting antivirals (DAAs) treatment are being considered revolutionary antiviral therapy, leading to infection cure by SVR in more than 90% of patients, without important side effects[3,5]
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