Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy.

INTRODUCTION

Direct-acting antivirals (DAA) are highly effective in patients in hemodialysis and chronic hepatitis C and brings multiple benefits to this population. Our aim was to evaluate the effectiveness of DAA treatment in routine clinical practice in Argentina using a multidisciplinary network.

MATERIALS AND

METHODS

In this prospective multicenter cohort study, all patients on dialysis at Fresenius Medical Care, were screened for anti-HCV. All HCV RNApositive patients were offered treatment with sofosbuvir/velpatasvir and glecaprevir/pibrentasvir. FIB-4 and APRI scores, and liver stiffness, were performed in all HCV RNA-positive patients. A network was developed where nephrologists, after an HCV management training program and under the supervision of hepatologists by telemedicine, initiated treatment in each dialysis unit; and DAAs therapy was provided by the patients' insurance or by the national Ministry of Health.

RESULTS

A total of 10 144 patients were evaluated between January 2018 and December 2023. A total of 323 (3.2 %) were anti-HCV positive, of which 149/323 (46.1%) had detectable HCV RNA. Genotype 1 was the more prevalent (69%) and most patients had mild fibrosis (26% had F3-F4). By May 2024, 82 patients were evaluated 12 weeks after the end of treatment: 76 (92.7%) achieved sustained virological response, three died, one stopped treatment due to intolerance, and two were lost to follow-up.

DISCUSSION: A multi-stakeholder partnership model (Fresenius Medical Care, physicians, insurance companies and Ministry of Health), implemented as a national microelimination strategy, has demonstrated increased treatment rates for HCV in dialysis units, exhibiting acceptable effectiveness.