Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Background: Hepatitis C virus (HCV) infection is highly prevalent among patients on hemodialysis (HD) and is associated with poor prognosis. Direct-acting antiviral (DAA) regimens improved the efficacy of chronic hepatitis C virus (HCV) treatment. Ombitasvir, paritaprevir boosted with ritonavir and possibly combined with ribavirin (OBV/PTV/r ±RBV) were licensed in the European Union in 2014 for use as a combination therapy for HCV infection. The three DAA, which contains 12.5 mg of OBV plus 75 mg of PTV boosted with 50 mg of ritonavir (OBV/PTV/r) are dedicated for the treatment of chronic hepatitis C in adults infected with genotype (GT) 1 and 4 .Therapy for genotype 1a and 1b is based on a fixed-dose regimen that includes OBV/PTV/r taken as 2 tablets once daily. The addition of a weight-adjusted dose of RBV is required in all patients infected with genotype 1a and 4 HCV. OBV/PTV/r ± RBV therapy should not be used in patients with advanced liver disease. Objectives: To study the efficacy and safety of OBV/PTV/r with or without ribavirin in chronic hepatitis c with ESRD patients on regular hemodialysis. Method: All cases (36) subjected to full history, liver function tests, complete blood count, bilirubin, albumin, coagulation profile, HCV Polymerase chain reaction (PCR), pelviabdominal ultrasound and ECHO heart before and after 12 weeks of treatment. Results: 36 patients received treatment for 12 weeks. HCV RNA was undetectable after 12weeks of treatment in 35 patients (97%) of cases. Conclusion: A combination therapy of ombitasvir/ paritaprevir/ritonavir with/without ribavirin for the treatment of HCV in patients on HD is highly effective with high SVR and causes minimal side effects. This regimen represents a major advance in disease management.The most significant side effect was anemia related to ribavirin use, which led to discontinuation of treatment

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