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Kidney Week

Abstract: SA-PO990

HCV Eradication Campaign in a Dialysis Clinic in Argentina: Nephrologists' Role in Patient Safety

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bevione, Pablo E., Fresenius Medical Care, Pilar, BUENOS AIRES, Argentina
  • Perretta, Fernando Javier, Fresenius Medical Care, Pilar, BUENOS AIRES, Argentina
  • Berhongaray, Esperanza, Fresenius Medical Care, Pilar, BUENOS AIRES, Argentina
Introduction

Hepatitis C (HCV) increases mortality in dialysis patients and carries a worse prognosis for transplant. Still outbreaks continue to be reported.
Direct antiviral agents (DAA) open the door to HCV free units with individual benefits and overall patient security.

Case Description

In 2016 eleven HCV patients were transferred to our zero prevalence clinic.
As Infection risk rises with the number of positive patients and DAA were recently available, medical decision was to start the fight against HCV.
Whole staff participation was of key impact. Remote hepathologist advice was enough except for complex cases.
ELISA III was used for screening. PCR and posterior genotiping were done as no pangenotypic was available.
Seven PCR + patientes were genotype 1b and two 1a.
Spontaneous viral clearence occured in one of three 1b acutely infected patients.
Three 1b patients were not treated due to their short life expectancy.
One patient had Hepatitis B (HBV) and HCV 1b coinfection requiring hepathologic surveillance. Cirrhosis did not developed but HBV activation ocurred after HCV sustained virologic response (SVR).
All Four HCV 1b patients were effectively treated with 90 day Viekira Pak Abbvie (Ombi/Pari/Rit/Dasa).
Two HCV 1a patients were treated with Viekira Pak + Ribavirin needing ESA adjustment and weekly Hb check.
Only one HCV 1a patient did not achieve response despite supervised compliance. Re-genotyping was done and pangenotypic scheduled.
No patient had cirrhosis nor was IV drug user.
Functional isolation was applied while viremic, general when SVR and "N2 functional isolation" while no viremic but waiting SVR.
No side effects but great relief was reported when SVR obtained.

Discussion

HCV eradication in the dialysis setting is an achievable goal even in 2019 Argentina.
Preventing harming our patients, lowering their mortality and even curing some part of their chronicity is becoming possible.
A clear north heading and a tight biosecurity are essential for a safe trip for our patients on care.