Dosage, Efficacy, and Safety of Direct-Acting Antivirals for Hepatitis C In Patients with Chronic Kidney Disease: Evidence Relevant to Pakistan
Raheel Khan, Suhail Iqbal Malik, Qazi Masroor Ali, Hafiz Muhammad Waseem, Sadaf Shafiq, Rashid Habib
DOI: http://doi.org/10.63139/aqamc.v2i1.0020
Keywords: Dosage, Efficacy, and Safety
ABSTRACT
Introduction: Chronic hepatitis C virus (HCV) infection remains highly prevalent in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), particularly in low- and middle-income countries such as Pakistan. Renal impairment alters drug pharmacokinetics and historically limited treatment options due to poor tolerability of interferon- and ribavirin-based regimens.
Objective: To review the dosage recommendations, efficacy, and safety of direct-acting antiviral agents (DAAs) currently available in Pakistan for the treatment of HCV infection in patients with renal impairment.
Methods: A narrative review was conducted using PubMed, PakMediNet, and international hepatology and nephrology guidelines. Evidence regarding pharmacokinetics, sustained virologic response (SVR), and adverse events of DAAs in patients with CKD stages 3–5 and ESRD was analyzed, with emphasis on regimens available locally, including sofosbuvir-, daclatasvir-, and velpatasvir-based therapies.
Results: Most DAAs are predominantly hepatically metabolized and can be safely used without dose adjustment in patients with mild to moderate renal impairment. Although sofosbuvir is renally excreted, accumulating real-world and clinical trial data suggest that standard-dose sofosbuvir-based regimens can be used cautiously in patients with severe renal impairment and those on dialysis when alternative regimens are unavailable. High SVR rates (>90%) and acceptable safety profiles have been reported across CKD stages, with anemia remaining the most common adverse effect when ribavirin is used.
Conclusion: Direct-acting antivirals have revolutionized the management of HCV in patients with CKD. In Pakistan, where therapeutic options may be limited, sofosbuvir-based regimens remain an effective and generally safe option for patients with renal impairment, though careful patient selection and monitoring are required. Further local data are needed to guide standardized treatment protocols.
Keywords: Dosage, Efficacy, and Safety