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HCV Treatment in CKD 5 — RACP Adult Medicine MCQ

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ModerateGastroenterologyHCV Treatment in CKD 5RACP Adult Medicine

A 60-year-old man with chronic HCV (genotype 1b) and CKD stage 5 (eGFR 8, on haemodialysis) is treatment-naïve. He has no cirrhosis. Most DAA regimens require renal dose adjustment. Which regimen is safe without dose adjustment in severe CKD?

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Correct answer: E — Glecaprevir/pibrentasvir 8 weeks

Glecaprevir/pibrentasvir is the preferred regimen for HCV in severe CKD/dialysis as both drugs are hepatically metabolised and do not require renal dose adjustment. Sofosbuvir-based regimens are renally cleared and historically contraindicated in eGFR <30 (though emerging data supports cautious use). Treatment duration is 8 weeks for treatment-naïve non-cirrhotic patients.

Reference: GESA – 2022 – HCV in CKD; AASLD/IDSA 2024; KDIGO 2024