Abstract: TH-PO911

Effectiveness of Direct-Acting Antiviral Regimens in the Treatment of Hepatitis C Virus Infection in a Diverse Dialysis Population

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Martin, Michelle T., University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
  • Tang, Ignatius Yun-Sang, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, United States
  • Lee, Todd, University of Illinois at Chicago, Chicago, Illinois, United States
Background

Direct-acting antiviral (DAA) regimens offer high sustained virologic response (SVR) in patients infected with the hepatitis C virus (HCV). However, clinical trial data in dialysis patients and real-world data in a multi-ethnic dialysis population are limited.

Methods

All HCV-infected dialysis patients who received DAA therapy at an urban academic medical center from 1/1/2014 to 12/1/2016 and had SVR data available were included in this single center retrospective review. Data collection included demographics, comorbidities, treatment regimen, and laboratory data. Descriptive statistics, Fisher’s exact test, and Pearson’s chi-square test were used for analysis.

Results

A total of 17 patients started treatment; SVR data were not available for 2 patients. Among the remaining 15 patients, the mean age was 63.1 (+6.9) years and BMI was 26.3 (+4.7) kg/m2, 80% were male, 60% African American, 67% cirrhotic, 80% treatment-naive, 27% had diabetes, and 20% had psychiatric illness. The HCV genotype mix was 67% 1a, 27% 1b, and 6% 2b. Forty percent had received organ transplants: 33% liver and 7% liver + kidney; 83% of transplant patients received tacrolimus for immunosuppression.

Sixty-seven percent of patients received elbasvir/grazoprevir, 20% elbasvir/grazoprevir + ribavirin, and 13% ledipasvir/sofosbuvir. SVR was achieved in all 15 patients (100%).

Fatigue was reported by 20% of patients. All 3 patients who received ribavirin experienced anemia. One patient received additional erythropoietin during dialysis and had a ribavirin dose reduction.

The SVR rates did not differ by genotype, regimen, cirrhosis, treatment history, ethnicity, gender, age, BMI, diabetes, psychiatric history, or transplant status. The SVR rates also did not differ by adherence; 13% of patients reported missing 1 dose of HCV medication during treatment.

Conclusion

Despite a high proportion of cirrhotic patients, all patients achieved SVR in this diverse dialysis patient population. While ledipasvir/sofosbuvir is not recommended for HCV-infected dialysis patients, both patients treated with this regimen achieved SVR. The SVR rates did not differ by treatment or demographics due to the 100% cure rate, and conclusions across groups are limited due to the small numbers. DAA regimens were well tolerated except for anemia in patients receiving ribavirin.