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

Table 4 Recommended regimens from the American Association for the Study of Liver Diseases and European Association for the Study of the Liver for patients with chronic hepatitis C and severe renal impairment (glomerular filtration rate < 30 mL/min) who need urgent hepatitis C virus therapy and renal transplantation is not an immediate option

HCV genotype	AASLD recommended regimen	EASL recommended regimen3
1	Elbasvir/grazoprevir for 12 wk (for 1a or 1b) or ombitasvir/paritaprevir/ritonavir plus dasabuvir1 (for 1b) for 12 wk	Elbasvir/grazoprevir or ombitasvir/paritaprevir plus dasabuvir (for 1a or 1b), for 12 wk (plus RBV 200 mg/d for 1a if the haemoglobin level is > 10 g/dL at baseline)
2, 3, 5 or 6	Pegylated interferon-alfa plus dose-adjusted ribavirin (200 mg daily)2	Sofosbuvir/velpatasvir or sofosbuvir plus daclatasvir (plus ribavirin if the haemoglobin level is > 10 g/dL at baseline for genotype 3) for 12 wk (or for 24 wk without ribavirin for genotype 3)4
4	Elbasvir/grazoprevir for 12 wk	Elbasvir/grazoprevir for 12 wk or ombitasvir/paritaprevir plus dasabuvir plus ribavirin (if the haemoglobin level is > 10 g/dL at baseline) for 12 wk

¹For HCV genotype 1a: Ombitasvir/paritaprevir/ritonavir plus Dasabuvir plus ribavirin at reduced doses (200 mg thrice weekly to daily) may be also used;

²Ribavirin should be discontinued when hemoglobin decreases by > 2 g/dL despite use of erythropoietin (or in case of severe anaemia (haemoglobin < 8.5 g/dL according to EASL guidelines);

³According to EASL guidelines: (1) antiviral therapy is indicated in those without an indication for kidney transplantation otherwise after kidney transplantation may be preferred; and (2) sofosbuvir should be used with caution (no dose recommendation can currently be given for these patients) and with careful monitoring of renal function;

⁴If treatment is urgently needed. HCV: Hepatitis C virus; AASLD: American Association for the Study of Liver Diseases; EASL: European Association for the Study of the Liver.