الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Chronic HCV infection is a global health problem that is associated with several hepatic and extra-hepatic disorders, including malignancies. The number of new cases, number of existing cases and the natural history of the infection all contribute to the burden of HCV-related disorders. Major variations exist in the burden of HCV infection and related diseases among different populations and geographical regions, as well as over time. Monitoring the possible change in natural history and burden of disease of HCV infection is important because of the availability of new direct-acting antiviral agents (DAAs) and the expected increase in patients cured of HCV infection.
Hepatitis C virus (HCV) affects over 70 million people worldwide, corresponding to 1.0% of the global population. Public interest in HCV is growing, especially since the virus can also induce extra-hepatic manifestations (in 40– 70% of cases) including autoimmunity-related symptoms, metabolic, renal, cardiovascular, central nervous system or lympho-proliferative disorders
Renal complications often appear in the context of cryoglobulinemia. Due to the persistence of the virus in the organism, an overstimulation of B lymphocytes occurs, leading to the production of mixed cryoglobulins (a group of globulins with the property of reversible precipitation at low temperatures).
In addition, patients with both advanced renal disease and severe hepatic impairment are largely left untreated, because the benefits of treating such patients with multi-organ failure are still uncertain. At this time, DAADs regimens used for renal insufficiency are not in patients
with severe hepatic impairment caused by hepatotoxicity recommended, impaired hepatic clearance of drugs, and a lack of data in decompensated cirrhosis
Understanding the efficacy, safety, and tolerability of novel DAADs in patients with CKD is important for clinicians treating HCV patients with this common comorbidity. The aim of this study is to evaluate and assess the efficacy and safety of DAADs therapies in the treatment of HCV for patients with concomitant CKD.
The aim of the study was to assess outcomes (efficacy, side effects, and possible complications) of DAADs for HCV in presence of CKD,
This was retrospective cohort study that was conducted at Aswan Fever Hospital and Luxor fever hospital for anti HCV therapy between Jan 2018 and July 2018 including 60 patients with all stages of CKD whom receiving DAADs were be recruited from both Aswan fever hospital and Luxor fever hospital.
The main results of the study revealed that:
Patient‘s age in patients from Aswan was ranged between 36-65 years with mean±S.D. 52.07±9.347 years while in patients from Luxor was ranged between 36-65 years with mean±S.D.
50.37±8.352 years. There was no statistically significant differences between groups.
Patient‘s HCV PCR in patients from Aswan at baseline show that all patients were positive while after 3 months 27(90%) were negative and 3(10%) were positive and after 6months all patients were negative while in patients from Luxor all patients were positive while after 3 months 28(93.3%) were negative and
2(6.7%) were positive and after 6 months all patients were negative. There was no statistically significant differences between groups.
Patient‘s albumin in patients from Aswan was ranged between 1-
4.80 with mean±S.D. 3.92±0.776 while in patients from Luxor was ranged between 1-7 with mean±S.D. 4.007±0.924. There was no statistically significant differences between groups.
Patient‘s Hb in patients from Aswan was ranged between 9.9-16.3 with mean±S.D. 12.247±1.821 while in patients from Luxor was ranged between 10-16.3 with mean±S.D. 12.78±1.655. There was no statistically significant differences between groups.
Patient‘s creatine in patients from Aswan was ranged between 1.7-
4.90 with mean±S.D. 2.55±0.837 while in patients from Luxor was ranged between 1.7-3.5 with mean±S.D. 2.257±0.468. There was
no statistically significant difference between groups.
Based on our finding, we recommend for further studies on large geographical scale and on larger sample size to emphasize our conclusion.
CONCLUSION
Treatment with newer DAAs is effective and safe for the treatment of HCV-infected chronic kidney disease patients, DAAs -based therapy is highly effective and well tolerated without any adverse impact on renal function in HCV-infected renal allograft recipients. Although initial results are promising, the long-term outcomes including breakthrough HCV replication and effect on progression of chronic liver disease are yet to be seen.
Recommendations
RECOMMENDATIONS
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
Evaluate HCV-positive CKD patients for direct-acting antiviral (DAA)–based therapy, tailored to HCV genotype and viral load, liver disease characteristics, and glomerular filtration rate. Evaluate patients with CKD stage V for kidney transplantation, regardless of HCV status.
Treat patients with HCV-associated glomerular disease with DAA- based therapy alone (for stable kidney disease or non-nephrotic proteinuria) or DAA-based therapy plus immunosuppressive therapy, with or without plasma exchange (for unstable kidney disease).