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

kidney cross section
kidney cross section
A minimal decrease in eGFR was found in patients with chronic hepatitis C taking oral direct-acting antiviral agents.

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).

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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.


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