Role of direct antiviral agents in treatment of chronic hepatitis C infection in renal transplant recipients

Abstract

Background: Since introduction of direct antiviral agents(DAA), morbidity of HCV has considerably decreased but still no guidelines have been formulated in renal transplant recipients(RTR). We studied efficacy and tolerability of direct antiviral agents in RTR Methods & Materials: This prospective observational study was conducted at Army Hospital Research-&-Referral, Delhi from June-2016 to May-2017. Forty-five HCV infected RTR with stable graft function were included. Results: Median time between renal transplantation and the start of anti-HCV therapy was 36 months (1-120months). Majority(66.7%) were infected with genotype3. Baseline median HCV-RNA level was 542648IU/ml (1189-55028534IU/ml). Sofosbuvir-Ribavirin combination (24weeks) was given to 30 patients including 3cirrhotics, Ledipasvir-Sofosbuvir combination to 8patients and Daclatasvir-Sofosbuvir combination to 7patients, including 2cirrhotics. Rapid-Virological-Response was observed in 29 patients treated with Sofosbuvir/Ribavirin, all 8 patients on Sofosbuvir/Ledipasvir and all 7 patients on Sofosbuvir/Daclatasvir. End-Treatment-Response and Sustained-Virological-Response (12weeks) was achieved in all patients irrespective of genotype or treatment regimen. Decrease in mean HCV-RNA level and transaminase level was statistically significant(p < 0.01). Ribavirin was significantly associated with anaemia(p = 0.032). Conclusion: DAA regimens are well tolerated and highly efficacious. Response to DAA is good irrespective of genotype, drug combination, initial HCV-RNA level, age or sex of patient or graft age. However, Sofosbuvir/Ledipasvir and Sofosbuvir/Daclatasvir combination is preferable.