Modest eGFR Decline With Direct-Acting Antivirals in Chronic Hepatitis C

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Concomitant use of tenofovir plus ritonavir-boosted HIV protease inhibitor does not seem to have an effect on eGFR.
Concomitant use of tenofovir plus ritonavir-boosted HIV protease inhibitor does not seem to have an effect on eGFR.

According to results published in the Journal of Viral Hepatitis, the estimated glomerular filtration rate (eGFR) only decreases slightly during therapy with all-oral direct-acting antivirals (DAAs) in patients with normal to moderately impaired renal function, regardless of a patient's HIV status.

The international prospective multi-cohort study included 1131 patients who had been treated with DAAs for at least 12 weeks and had eGFR ≥30 mL/min/1.73 m² at baseline. Of these, 58% were patients coinfected with HIV/hepatitis C virus (n=658). All patients were taking oral medication regimens with at least 2 DAAs, including sofosbuvir in combination with either ledipasvir, simeprevir, or daclatasvir, or ritonavir-boosted paritaprevir plus ombitasvir with or without dasabuvir.

The researchers sought to assess the impact of DAAs against hepatitis C virus infection on the eGFR in clinical practice. To do so, they looked at eGFR at week 12 of follow-up after the scheduled end of a patient's therapy date.

Among the 901 patients treated for 12 weeks, median (interquartile range) eGFR was 100 mL/min/1.73 m² at baseline vs 97 mL/min/1.73 m² at week 12 of follow-up posttreatment (P <.001).

For patients with HIV coinfection who received tenofovir plus a ritonavir-boosted HIV protease inhibitor, both baseline median eGFR and eGFR at week 12 of follow-up were 104 mL/min/1.73 m² (P =.913).

The effects on eGFR persisted for up to 12 weeks after stopping treatment.

“The present study provides evidence that the use of the currently used all-oral DAA-based therapy is associated with a minimal decrease in eGFR in subjects with normal to moderately impaired renal function, regardless of HIV coinfection,” the study authors concluded.

Reference

Alvarez-Ossorio MJ, Sarmento e Castro R, Granados R, et al. Impact of interferon-free regimens on the glomerular filtration rate during treatment of chronic hepatitis C in a real-life cohort [published online January 28, 2018]. J Viral Hepat. doi:10.1111/jvh.12867

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