Hepatitis C treatment for those on dialysis

Hepatitis C has become a major problem for dialysis patients in India. Blood transfusions, reuse of dialyzers and poor infection control practices are associated with a higher cross-infection rate. Another major problem is that even after infection, the virus is not detected by the commonly used Anti HCV Antibodies test for 4-6 weeks. This means that patients would be assumed to be negative for the virus despite getting tested. In this process other patients could get cross infected. Hepatitis C infection is more common among those on dialysis for a long period of time. 

For many years, Hepatitis C positive dialysis patients had to rely on traditional treatments like Interferon and Pegylated Interferon which did not have high success rates. They also had significant side effects. Further Ribavirin, to be used along with Interferon for effective treatment caused severe side effects among dialysis patients and hence could rarely be used. This further reduced the success rates of treatment.

The advent of Direct Acting Agents such as Sofosbuvir has ushered in a new era in the treatment of Hepatitis C in dialysis patients. These are all oral drugs to be taken for 3 months mostly and success rates have been very high.

Earlier Hepatitis C used to be treated only if the dialysis patient was about to go for a kidney transplant. It was not worth the hassle otherwise. But now, things are changing and most dialysis patients are encouraged to get their Hepatitis C treated. Left untreated, Hepatitis C can lead to liver cirrhosis and liver failure. The new KDIGO guidelines draft for Hepatitis C in CKD patients recommend that all CKD patients with Hepatitis C be treated with a Direct Acting Agent based regimen.

Many patients think that since Hepatitis C is fairly docile and does not cause any immediate, urgent symptoms, why bother treating it? The problem is over a period of time, Hepatitis C can cause a lot of problems. Especially after a few years, the liver can become badly affected and this could severely impair quality of life in many ways.

These days the cost of treatment has also come down significantly. So, if you are on dialysis and are Hepatitis C positive, you should definitely consider treatment. Talk to your nephrologist and discuss treatment options.