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Hepatitis C virus infection, with both hepatic and extrahepatic manifestations, is an important issue for patients requiring renal replacement therapy (RRT) and for those who receive kidney transplants (KT). Registry studies show a clear adverse impact of HCV-positivity on RRT patient survival and on KT graft and patient survival.1 In pretransplant and post-transplant settings, HCV-positivity (vs uninfected patients) is clearly associated with a relatively increased liver-related mortality and morbidity. However, reflecting the frequent comorbid cardiovascular disease that is observed in these settings, the absolute risk for cardiovascular mortality is much greater than risk of HCV-related mortality in patients with RRT and KT. Remarkably, the risk for cardiovascular disease appears increased in HCV-positive versus HCV-negative patients.
There are obvious merits in HCV clearance for selected patients on RRT. Successful treatment should prevent or substantially reduce the risk for liver-related problems including hepatic decompensation and primary liver cancer. These problems are also avoided by patients with KT who undergo successful treatment before transplantation. Also, HCV-related renal diseases that may affect the transplanted kidney could be prevented by successful antiviral treatment before transplantation. It has not been shown, though it is possible, that HCV clearance might ameliorate the adverse impact of infection on cardiovascular complications before and after transplantation.
There have been major recent and ongoing advances in the antiviral treatment of hepatitis C infection. However, these advances have been mainly translated to the benefit of non-transplant patients with normal or adequate renal function. For more than a decade, pegylated interferon (peg-IFN) and ribavirin combination of drugs was the treatment for all genotypes of HCV infection. Unfortunately, this antiviral treatment has proven toxic and difficult to deliver in the RRT setting. Peg-IFN needs to be given at a reduced …