Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy.
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| Title: | Hepatitis C virus microelimination program in hemodialysis patients: success of a multi-stakeholder partnership based on a national eradication strategy. |
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| Alternate Title: | Programa de microeliminación del virus de hepatitis C en pacientes en hemodiálisis: éxito de una alianza multi-sector basada en una estrategia nacional de erradicación. |
| Authors: | Ridruejo, Ezequiel1 (AUTHOR) eridruejo@cemic.edu.ar, Laham, Gustavo2 (AUTHOR), Alonso, Soledad3 (AUTHOR), Vallejos, Augusto4 (AUTHOR), Silva, Marcelo O.5 (AUTHOR), Ferder, Marcelo D.6 (AUTHOR), Dorado, Enrique G.6 (AUTHOR), Mauro, Ezequiel3 (AUTHOR), Puddu, Marcelo H.6 (AUTHOR) |
| Source: | Medicina (Buenos Aires). nov/dic2025, Vol. 85 Issue 6, p1189-1197. 9p. |
| Subjects: | HEMODIALYSIS, DISEASE eradication, HEPATITIS C, DIAGNOSTIC virology, ANTIVIRAL agents |
| Geographic Terms: | ARGENTINA |
| Abstract: | Introduction: Direct-acting antivirals (DAA) are highly effective in patients in hemodialysis and chronic hepa titis C and brings multiple benefits to this population. Our aim was to evaluate the effectiveness of DAA treat ment in routine clinical practice in Argentina using a multidisciplinary network. Materials and methods: In this prospective multi center cohort study, all patients on dialysis at Fresenius Medical Care, were screened for anti-HCV. All HCV RNA-positive patients were offered treatment with sofosbu vir/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' insur ance 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 evalu ated 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 compa nies and Ministry of Health), implemented as a national microelimination strategy, has demonstrated increased treatment rates for HCV in dialysis units, exhibiting ac ceptable effectiveness. Introducción: Los antivirales de acción directa (AAD) son altamente eficaces en pacientes en hemodiálisis con hepatitis C crónica (VHC) y aportan múltiples beneficios en esta población. Nuestro objetivo fue evaluar la efec tividad del tratamiento con AAD en la práctica clínica rutinaria en Argentina. Materiales y métodos: En este reporte de cohorte prospectivo y multicéntrico, se realizó tamizaje de an tiVHC en todos los pacientes en Fresenius Medical Care. A los pacientes con ARN detectable se les ofreció tra tamiento con AAD. Se les determinó los índices FIB-4 y APRI, así como la rigidez hepática. Se desarrolló una red donde los nefrólogos, bajo la supervisión de un hepató logo mediante telemedicina, empezaron el tratamiento; y los AAD fueron provistos por la cobertura médica o por el Ministerio de Salud de la Nación. Resultados: Entre enero de 2018 y diciembre de 2023, se evaluaron 10 144 pacientes; 323 (3.18%) fueron po sitivos para antiVHC, y 149/323 (46.1 %) tenían ARN detectable. El genotipo 1 fue el más prevalente (69%) y la mayoría presentaba fibrosis leve (26% F3-F4). Para mayo de 2024, 82 pacientes fueron evaluados 12 semanas después de finalizar el tratamiento 76 (92.6%) lograron respuesta virológica sostenida, tres fallecieron, uno interrumpió el tratamiento por intolerancia y dos se perdieron en el seguimiento. Discusión: Un modelo de alianza multi-actor (Frese nius Medical Care, médicos, cobertura de salud y Minis terio de Salud), implementado como estrategia nacional de microeliminación, ha demostrado un aumento en las tasas de tratamiento del VHC en unidades de diálisis, con una efectividad aceptable. [ABSTRACT FROM AUTHOR] |
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| Abstract: | Introduction: Direct-acting antivirals (DAA) are highly effective in patients in hemodialysis and chronic hepa titis C and brings multiple benefits to this population. Our aim was to evaluate the effectiveness of DAA treat ment in routine clinical practice in Argentina using a multidisciplinary network. Materials and methods: In this prospective multi center cohort study, all patients on dialysis at Fresenius Medical Care, were screened for anti-HCV. All HCV RNA-positive patients were offered treatment with sofosbu vir/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' insur ance 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 evalu ated 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 compa nies and Ministry of Health), implemented as a national microelimination strategy, has demonstrated increased treatment rates for HCV in dialysis units, exhibiting ac ceptable effectiveness. Introducción: Los antivirales de acción directa (AAD) son altamente eficaces en pacientes en hemodiálisis con hepatitis C crónica (VHC) y aportan múltiples beneficios en esta población. Nuestro objetivo fue evaluar la efec tividad del tratamiento con AAD en la práctica clínica rutinaria en Argentina. Materiales y métodos: En este reporte de cohorte prospectivo y multicéntrico, se realizó tamizaje de an tiVHC en todos los pacientes en Fresenius Medical Care. A los pacientes con ARN detectable se les ofreció tra tamiento con AAD. Se les determinó los índices FIB-4 y APRI, así como la rigidez hepática. Se desarrolló una red donde los nefrólogos, bajo la supervisión de un hepató logo mediante telemedicina, empezaron el tratamiento; y los AAD fueron provistos por la cobertura médica o por el Ministerio de Salud de la Nación. Resultados: Entre enero de 2018 y diciembre de 2023, se evaluaron 10 144 pacientes; 323 (3.18%) fueron po sitivos para antiVHC, y 149/323 (46.1 %) tenían ARN detectable. El genotipo 1 fue el más prevalente (69%) y la mayoría presentaba fibrosis leve (26% F3-F4). Para mayo de 2024, 82 pacientes fueron evaluados 12 semanas después de finalizar el tratamiento 76 (92.6%) lograron respuesta virológica sostenida, tres fallecieron, uno interrumpió el tratamiento por intolerancia y dos se perdieron en el seguimiento. Discusión: Un modelo de alianza multi-actor (Frese nius Medical Care, médicos, cobertura de salud y Minis terio de Salud), implementado como estrategia nacional de microeliminación, ha demostrado un aumento en las tasas de tratamiento del VHC en unidades de diálisis, con una efectividad aceptable. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 00257680 |
