HCV Relapse in Hemodialysis Egyptian Patients after Treatment with Direct Acting Antiviral Drugs

Abstract Background HCV infection is a major health problem in Egypt and unfortunately its prevalence is more in hemodialysis patients than general population, the advent of DAA led to increased rate of recovery and lower rates of side effects rather than standard interferon therapy, but relapse of HCV is not uncommon among these patients. Purpose: the aim of the current study was to assess the incidence of relapse among hemodialysis patients with HCV after treatment with different regimens DAAs and to identify the risk factors that might be associated with this relapse. Patients and Methods This case- control study was held in Shibin El-Kom Teaching Hospital, Menoufia, Egypt in the period between June 2015 and June 2020. The study included 250 hemodialysis patients with chronic HCV and previously treated with DAAs. Patient were classified according to DAA treatment response into patients with HCV relapse (186 patients) and a non-relapse group(64 patients).both groups were assessed regarding predictors and risk factors for HCV relapse. Results There were no statistically significant differences between both groups as regard age, sex, diabetes and ischemic heart disease. Hypertension was prevalent in non-relapse group with statistical significance(p = 0.0001). Sofosbuvir + Daclatasvir + Ribavirin regimen was the most commonly used regimen in relapse group (53.2%0 while Ritonavir/Ombitasvir/Paritaprevir+Ribavirin combination therapy was utilized more in non- relapse group, both showed statistical significance (p = 0.0001). HCV viral load, liver cirrhosis and hepatic focal lesion were predictors of treatment non-response. Conclusion In conclusion, multiple risk factors exist for HCV relapse after primary response to direct acting antiviral. These factors included hypertension, cirrhotic liver, presence of space occupying lesions, Sofosbuvir- based regimen, degree of hypoalbuminemia, degree of liver enzymes elevation, high bilirubin, and elevated alfa fetoprotein and viral load by HCV PCR. cirrhotic liver, space occupying lesions, sofosbuvir- based regimen and high alfa fetoprotein are the most significant predictors for HCV recurrence after primary response to direct acting antiviral in hemodialysis population.