NOVEL DIRECT ACTING ANTIVIRAL REGIMENS FOR PATIENTS WITH CHRONIC HEPATITIS C AND CHRONIC KIDNEY DISEASE STAGE 3 TO STAGE 5D

Objective: To assess the safety and efficacy of Sofosbuvir based Antiviral regimens for chronic hepatitis C virus infected patients with chronic kidney disease stage 3 to stage 5D on haemodialysis. Study Design: Quasi experimental study. Place and Duration of Study: Nephrology Department, Combined Military Hospital Lahore, from Dec 2018 to Dec 2019. Methodology: Fifty patients of chronic kidney disease with stage 3 to stage 5D suffering from chronic hepatitis C were selected. Among them 30 patients were stage 3 to stage 5ND pre-dialysis patients while 20 were patients of End Stage Renal Disease (ESRD) on maintenance haemodialysis. Antiviral treatment consisted of Peg Interferon with Sofosbuvir and Ribavirin, Peg Interferon with Sofosbuvir, Ledipasvir with Sofosbuvir, Velpatsvir with Sofosbuvir and Daclatasvir with Sofosbuvir for 12 weeks. The assessments were conducted at baseline, weeks 2, 4, 8 and 12 on treatment and 12 weeks after treatment. Results: Sustained Virologic Response (SVR) was 96.8% for group treated with Ledipaspavir, Velpatsvir or Declatasvir with Sofosbuvir and 88.9% of patients in Peg IFN/Sofosbuvir/Ribavirin treated group achieved Sustained Virologic Response. Majority (90%) of the participants experienced adverse effects. Two (4%) patient on haemodialysis had treatment discontinuation due to side effects. Dose of Ribavirin was reduced in 4 (8%) patients on haemodialysis during antiviral therapy. Two deaths occurred during the study while on treatment and one death occurred four days after renal transplant. Conclusion: Sofosbuvir based antiviral regimens i.e. Peg Interferon with and without Ribavirin, Ledipasvir, Velpatsvir and Declatasvir for chronic Hepatitis C infected chronic kidney disease patients including haemodialysis patients, are well tolerated, effective and safe for treatment