Consensus recommendations for treatment of HCV in people with renal impairment

Consensus recommendationsGrade
Renal function must be evaluated in all individuals before initiating antiviral therapy for HCV infection.A1
All people with chronic HCV infection and renal impairment (eGFR < 50 mL/min/1.73 m2) should be referred to a specialist for assessment and management of HCV as well as their renal disease.A1
In people with mild–moderate renal impairment (eGFR, 30–80 mL/min/1.73 m2), no dose adjustment is required for:
• sofosbuvir + velpatasvir
• sofosbuvir + ledipasvir
• sofosbuvir + daclatasvir
• paritaprevir–ritonavir + ombitasvir + dasabuvir
• elbasvir + grazoprevir
A1
Ribavirin should be used with caution in people with an eGFR < 50 mL/min/1.73 m2
treatment should be supervised by a specialist experienced in the treatment of HCV.
A1
In people with severe renal impairment (eGFR < 30 mL/min/1.73 m2 or haemodialysis):
• sofosbuvir cannot be recommended, pending further studiesB1
• elbasvir + grazoprevir can be used to treat Gt 1a, 1b and 4 HCVA1/B1
• paritaprevir–ritonavir + ombitasvir + dasabuvir can be used to treat Gt 1a HCVB1
• low-dose ribavirin should be used with close monitoring of haemoglobin levels (eg, ribavirin 200 mg daily for patients not on haemodialysis; ribavirin 200 mg pre-dialysis for patients on haemodialysis)B1
 

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