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Direct-Acting Antiviral Agents for HCV-Associated Glomerular Disease and the Current Evidence

1
Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
2
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
3
Hepatology Section, Department of Medicine, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno “CEMIC’’, Ciudad Autonoma de Buenos Aires C1425ASG, Argentina
4
Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Provincia de Buenos Aires B1629AHJ, Argentina
5
Latin American Liver Research, Educational and Awareness Network (LALREAN), Pilar, Provincia de Buenos Aires B1629AHJ, Argentina
*
Author to whom correspondence should be addressed.
Pathogens 2019, 8(4), 176; https://doi.org/10.3390/pathogens8040176
Received: 16 August 2019 / Revised: 28 September 2019 / Accepted: 28 September 2019 / Published: 4 October 2019
(This article belongs to the Special Issue Hepatitis C Virus Infections)
Glomerular disease is an extra-hepatic manifestation of hepatitis C virus infection (HCV) and membranoproliferative glomerulonephritis is the most frequent glomerular disease associated with HCV. It occurs commonly in patients with HCV-related mixed cryoglobulinemia syndrome. Patients with HCV-related glomerular disease have been historically a difficult-to-treat group. The therapeutic armamentarium for HCV-related glomerular disease now includes antiviral regimens, selective or non-specific immunosuppressive drugs, immunomodulators, and symptomatic agents. The treatment of HCV-associated glomerular disease is dependent on the clinical presentation of the patient. The recent introduction of all-oral, interferon (IFN)-free/ribavirin (RBV)-free regimens is dramatically changing the course of HCV in the general population, and some regimens have been approved for HCV even in patients with advanced chronic kidney disease. According to a systematic review of the medical literature, the evidence concerning the efficacy/safety of direct-acting antiviral agents (DAAs) of HCV-induced glomerular disease is limited. The frequency of sustained virological response was 92.5% (62/67). Full or partial clinical remission was demonstrated in many patients (n = 46, 68.5%) after DAAs. There were no reports of deterioration of kidney function in patients on DAAs. Many patients (n = 29, 43%) underwent immunosuppression while on DAAs. A few cases of new onset or relapsing glomerular disease in patients with HCV successfully treated with DAAs have been observed. In summary, DAA-based combinations are making easier the management of HCV. However, patients with HCV-induced glomerular disease are still a difficult-to-treat group even at the time of DAAs. View Full-Text
Keywords: direct-acting antiviral agents; glomerulonephritis; hepatitis C virus; mixed cryoglobulinemia; proteinuria; sustained virological response direct-acting antiviral agents; glomerulonephritis; hepatitis C virus; mixed cryoglobulinemia; proteinuria; sustained virological response
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Fabrizi, F.; Cerutti, R.; Porata, G.; Messa, P.; Ridruejo, E. Direct-Acting Antiviral Agents for HCV-Associated Glomerular Disease and the Current Evidence. Pathogens 2019, 8, 176.

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