Consensus recommendations

Consensus recommendations

Grade

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
  • glecaprevir + pibrentasvir
  • elbasvir + grazoprevir

A1

If indicated, 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 currently be recommended, pending an update to the product information*
  • glecaprevir + pibrentasvir can be used to treat Gt 1–6 HCV
  • elbasvir + grazoprevir can be used to treat Gt 1a, 1b and 4 HCV
  • if indicated, low-dose ribavirin should be used (eg, ribavirin 200 mg daily for patients not on haemodialysis; ribavirin 200 mg pre-dialysis for patients on haemodialysis), with close monitoring of haemoglobin levels
  • B1

  • A1
  • A1/B1
  • B1

* It is anticipated that the product information for sofosbuvir + velpatasvir and sofosbuvir + velpatasvir + voxilaprevir will be updated later in 2020 to recommend that no dosage adjustment is required for patients with any degree of renal impairment, including patients requiring dialysis.