الفهرس 
Comparison between Sofosbuvir free regimen and Sofosbuvir based regimens in the treatment of chronic HCV patients with chronic renal failure
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Abstract
Hepatitis C virus (HCV) infection is a major burden due to its chronic complications like liver cirrhosis, portal hypertension, and hepatocellular carcinoma, in Egypt as it affects 15% of the population. The main way of treatment depends upon direct acting antivirals (DAAs). It was implied earlier that Sofosbuvir (SOF), a nonstructural 5B polymerase inhibitor effective with all known HCV genotypes which is renally excreted, better be avoided for potential toxic effects in patients with moderate to severe renal impairment especially those with estimated glomerular filtration rate (eGFR) < 30 mL/minute/1.73 m2 and on haemodialysis. This study aims to evaluate the efficacy and safety of SOF-based regimens against SOF-free in this special population of patients
Methods: This is a retrospective study where data available for all chronic HCV patients with chronic kidney disease (CKD) GFR < 60 mL/minute/1.73 m2 including those with end stage renal disease (ESRD) and on haemodialysis from 2018 to 2020 were reviewed. And 6607 patients were enrolled into this study who were considered suitable for treatment according to the National Committee for Control of Viral Hepatitis (NCCVH) in Egypt; these patients received variety of DAAs including SOF- based and SOF-free regimens, and were categorized into two groups based on that, with special concern to renal profile in addition to the efficacy and safety of SOF- based regimens in these patients.
Results: Sustained virological response (SVR) rate in this study was of 98.3%; 98.7% for those who were on SOF-based regimen and 95.6% for those administered SOF-free regimen. Regarding patients who were on haemodialysis, SVR rate was 100% in patients who received SOF-based regimen opposite to SVR rate of 91.2% in those who received SOF-free regimen. Moreover, in patients with moderate renal affection ‘grade 3 CKD’ SVR rates were 98.7% with SOF-based regimens and 97.6% for SOF-free regimens. Fifty one patients (0.8%) discontinued treatment of which 0.7% with SOF-based regimen and 1.5% with SOF-free regimen. Higher fibrosis-4 (Fib-4) score and low albumin ˂3g/dL were significantly associated with the treatment failure
Conclusion: SOF-based regimens at full dose are considered more effective than SOF-free regimens in patients with moderate to severe renal impairment and acquires very good safety profile and better SVR rate with insignificant or no effect on renal functions.