Interferon-free regimens in patients with hepatitis C infection and renal dysfunction or kidney transplantation

Table 1 Main characteristics of the approved direct acting antivirals that are currently used for the treatment of hepatitis C

DAA (commercial name), dose	Category	Dose adjustment in renal impairment	Antiviral activity	CNIs co-administration
Sofosbuvir (Sovaldi®), tablet 400 mg, once daily	Nucleotide analogue NS5B polymerase inhibitor	Contraindicated in patients with GFR < 30 mL/min	Genotypes 1-6	No change
			High genetic barrier
Simeprevir (Olysio®), tablet 150 mg, once daily with food	NS3/4A protease inhibitor	No change in renal impairment	Genotypes 1,4	Contraindicated with cyclosporine
			Low genetic barrier
Daclatasvir (Daklinza®), tablet 60 mg, once daily	NS5A inhibitor	No change in renal impairment	Genotypes 1, 2, 3, 4	No change
			Low genetic barrier
Ledipasvir/sofosbuvir/(Harvoni®), tablet 90/400 mg, once daily	NS5A inhibitor + nucleotide analogue NS5B polymerase inhibitor	Contraindicated in patients with GFR < 30 mL/min	Genotypes 1, 4, 5, 6	No change
			High genetic barrier
Ombitasvir/paritaprevir/ritonavir (Viekirax®), tablet 12.5/75/50 mg, two once daily with food	NS5A inhibitor + NS3/4A protease inhibitor boosted by ritonavir boosted	No change in renal dysfunction	Genotypes 1, 4	Cyclosporine: 20% of pretreatment total daily dose; tacrolimus: 0.2 mg/72 h or 0.5 mg once weekly
			Genetic barrier depending on HCV genotype
Dasabuvir (Exviera®), tablet 250 mg, every 12 h	Non-nucleos(t)ide analogue NS5B polymerase inhibitor	No change in renal dysfunction	Genotype 1
			Low genetic barrier
Elbasvir/Grazoprevir (Zepatier®), tablet 100/50 mg, once daily	NS5A inhibitor + NS3/4A inhibitor	No change in renal dysfunction	Genotypes 1,4	Co-administration increases tacrolimus concentrations
Velpatasvir/sofosbuvir/(Epclusa®), tablet 100/400 mg, once daily	NS5A inhibitor + nucleotide analogue NS5B polymerase inhibitor	Contraindicated in patients with GFR < 30 mL/min	Genotypes 1-6	No change
			High genetic barrier

CNI: Calcineurin inhibitor; DAA: Direct acting antiviral; GFR: Glomerular filtration rate.