Webinar series: Treatment Update on Hepatitis C management in Chronic Kidney Disease

Description of the Webinar

It is estimated that 170 million people worldwide are chronically infected with the hepatitis C virus (HCV). Globally, complications attributable to the natural course of HCV infection such as cirrhosis and liver cancers are estimated to cause over 1 million deaths annually. This webinar gives a treatment update on the HCV disease in CKD, focusing on its management and patients receiving hemodialysis. 

The webinar webcasts

This webinar series was split into two different talks followed by a Q&A session. 

Part I : Hepatitis C Virus (HCV) management in Chronic Kidney Disease (CKD) 

Description: 

The incidence of chronic HCV infection in CKD in Europe is estimated to be 0.2% to 3.5%.  However, the true incidence and prevalence of HCV in developing countries is difficult to estimate.  The American Association for the Study of Liver Disease (AASLD),  the European Association for the Study of the Liver (EASL) and Kidney Disease: Improving Global Outcomes (KDIGO) recommend use of anti-HCV antibodies as the first line diagnostic test for HCV infection. These tests are readily available in developed countries through laboratory based testing. However, to meet the global challenges for HCV disease eradication, additional expansion of testing platforms such as point of care lateral flow tests and amplification techniques for quantitative viral load and genotyping is needed with emerging interferon free HCV treatment regimens.  Both AASLD and EASL guidelines have stated that the goal of HCV therapy is to eradicate HCV infection prevent hepatic cirrhosis, decompensation of cirrhosis, HCC, and death. However, there is no longer a role for use of pegylated interferons and ribavirin alone or with 1st generation Directly Acting Agents (DAA) for the treatment of HCV infection. The current challenge facing CKD patients is that although second generation DAAs are highly effective and achieve high Sustained Virologic Response (SVR) rates for all genotypes, use of these drugs are currently limited in that safety data is yet not available for patients with CrCl ?30 mL/minute or with end stage renal disease.

Part II : Hepatitis C Virus (HCV) in Chronic Kidney Disease (CKD) patients receiving hemodialysis.

Description: 

The incidence of chronic HCV in hemodialysis patients is estimated to be 11.5% in the European population and 7.4% in the US population.  There have been limited clinical trials investigating the efficiency of HCV treatment in CKD patients receiving hemodialysis, and past trials using interferon and ribavirin enrolled small number of patients with variable sustained Virologic Response (SVR) rates and high frequency of toxicity and treatment dropout rates. Moreover, while both the American Association for the Study of Liver Disease (AASLD) and the European Association for the Study of the Liver (EASL) guidelines have stated that the goal of HCV therapy is to eradicate HCV infection, there is clearly no longer a role for use of pegylated interferon/ribavirin therapy alone or with 1st generation Directly Acting Agents (DAA) for the treatment of HCV infection. However, safety data is yet not available for treatment with 2nd generation DAAs in patients with CrCl ?30 mL/minute or with end stage renal disease, including those requiring hemodialysis thus presenting a significant dilemma for treating such patients, especially renal transplant candidates.

About the Facilitator

Dr. de Comarmond is an Associate Professor of Medicine at Wake Forest University and Virginia College of Osteopathic Medicine and currently Chief of the Medicine Department at the Salisbury VAMC. The Salisbury VAMC is one the largest hepatitis C treatment Centers within the Veteran Health Affairs Healthcare System. Dr. de Comarmond’s area of clinical interest include  HCV diagnostics and treatment, and disease prevention.