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Review
. 2023 Jul;30(4):343-355.
doi: 10.1053/j.akdh.2023.04.003.

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

Purva Sharma  1 , Rani Sawtell  2 , Qiyu Wang  2 , Meghan E Sise  3
Affiliations
Review

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

Purva Sharma et al. Adv Kidney Dis Health. 2023 Jul.

Abstract

Treatment of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection poses unique challenges in patients with kidney disease. Direct-acting antivirals have been a major breakthrough in eradicating HCV infection, and several pangenotypic regimens are available for patients with chronic kidney disease or end-stage kidney disease requiring dialysis with high cure rates and no need for dose adjustment. Direct-acting antiviral therapy alone can treat HCV-associated cryoglobulinemic glomerulonephritis; concurrent antiviral and immunosuppressive therapy is needed for cases of severe, organ-threatening manifestations of cryoglobulinemia. Immunosuppression may be needed for HBV-associated kidney disease (polyarteritis nodosa or membranous nephropathy) when there is evidence of severe immune-mediated injury while weighing the risk of potential viral activation. Most HBV antiviral agents need to be dose-adjusted in patients with chronic kidney disease or end-stage kidney disease requiring dialysis, and drug-drug interactions need to be carefully evaluated in patients with kidney transplants. Considerations for accepting HCV- and HBV-infected donors for kidney transplantation are discussed.

Keywords: Hepatitis C virus; cryoglobulinemia; hepatitis B virus; liver disease; membranous.

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Conflict of interest statement

Conflict of interest: MES has received research grants from Gilead, Merck, Abbvie related to Hepatitis C and kidney disease. The remaining authors have nothing to declare

Figures

Figure 1.
Figure 1.. Clinicopathological features and treatment of HCV-associated cryoglobulinemic glomerulonephritis
Made using Biorender. Abbreviations eGFR = estimated glomerular filtration rate, RPGN = rapidly progressive glomerulonephritis, HCV = hepatitis C virus, RNA = ribonucleic acid, GBM = glomerular basement membrane, PAS = periodic acid-Schiff, DAAs = direct-acting antivirals.
Figure 2.
Figure 2.. Approaches to managing HBV associated kidney disease
Made using Biorender. Abbreviations: HBV = Hepatitis B virus, GFR = glomerular filtration rate, NAs = nucleoside/nucleotide analogues.
Figure 3.
Figure 3.. Antiviral therapies for HBV in patients with kidney disease
Made using Biorender. Abbreviations: HBV = Hepatitis B virus, eGFR = estimated glomerular filtration rate, NAs = nucleoside/nucleotide analogues, HBsAg = Hepatitis B surface antigen
See this image and copyright information in PMC

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