Management of Hepatitis C Virus and Hepatitis B Virus Infection in the Setting of Kidney Disease

Abstract

Background: Chronic kidney disease (CKD) increases susceptibility to hepatitis B and C infections, both of which complicate renal management and elevate morbidity, particularly in populations with frequent healthcare exposures. There is limited real-world evidence on the efficacy and safety of modern antiviral regimens for these patients, especially in low-resource settings. Objective: This study aimed to evaluate the effectiveness and safety of direct-acting antivirals for hepatitis C virus (HCV) and nucleus(t)ide analogues for hepatitis B virus (HBV) in patients with CKD stages 3–5, focusing on virologic response, renal function, and adverse events. Methods: In this prospective observational cohort (n = 75), adults aged 18–65 years with CKD stage 3–5 and chronic HBV or HCV, but without cirrhosis, HIV co-infection, or prior transplantation, were consecutively recruited at two tertiary centers in Pakistan between March 2024 and February 2025. Antiviral regimens included sofosbuvir-based DAAs for HCV and either tenofovir or entecavir for HBV, with clinical and laboratory assessment over 24 weeks. Primary outcomes were sustained virologic response (SVR12 for HCV; undetectable HBV DNA at week 24) and change in eGFR; adverse events were monitored throughout. Ethical approval was obtained in accordance with the Helsinki Declaration. Statistical analysis employed SPSS v24 with chi-square and paired t-tests as appropriate. Results: Among 75 participants (mean age 53.2 years), SVR12 was achieved in 95.2% of HCV and HBV DNA suppression in 87.9% of HBV cases. There was no significant change in mean eGFR (baseline 43.6 ± 12.7 vs. post-treatment 42.8 ± 13.1; p = 0.382), and adverse event rates were low (9.3%), with no serious renal or hepatic complications reported. Conclusion: Modern antiviral therapy for HBV and HCV in CKD patients delivers high rates of virologic suppression and biochemical normalization without adversely affecting renal function, supporting their routine use in nephrology care and improving outcomes in high-risk populations