Consensus recommendations

Consensus recommendations

Grade

Renal function must be evaluated in all individuals before initiating antiviral therapy for HCV infection.

A1

All people with chronic HCV infection and renal impairment (eGFR < 50 mL/min/1.73 m2) should be referred to a specialist for assessment and management of HCV as well as their renal disease.

A1

In people with mild–moderate renal impairment (eGFR, 30–80 mL/min/1.73 m2), no dose adjustment is required for:

  • sofosbuvir + velpatasvir
  • sofosbuvir + ledipasvir
  • sofosbuvir + daclatasvir
  • glecaprevir + pibrentasvir
  • elbasvir + grazoprevir

A1

Ribavirin should be used with caution in people with an eGFR < 50 mL/min/1.73 m2; treatment should be supervised by a specialist experienced in the treatment of HCV.

A1

In people with severe renal impairment (eGFR < 30 mL/min/1.73 m2 or haemodialysis):

  • sofosbuvir cannot be recommended, pending further studies
  • glecaprevir + pibrentasvir can be used to treat Gt 1–6 HCV
  • elbasvir + grazoprevir can be used to treat Gt 1a, 1b and 4 HCV
  • paritaprevir–ritonavir + ombitasvir + dasabuvir can be used to treat Gt 1a and 1b HCV
  • low-dose ribavirin should be used with close monitoring of haemoglobin levels (eg, ribavirin 200 mg daily for patients not on haemodialysis; ribavirin 200 mg pre-dialysis for patients on haemodialysis)
  • B1
  • A1
  • A1/B1
  • B1
  • B1