Hepatitis C and Kidney Disease

This evening from 6-8 PM at the Mass General was a nice interdisciplinary symposium regarding Hepatitis C with a particular focus on kidney disease. The session was organized by Dr. Meghan Sise, a MGH nephrologist. The attendees included nephrologists, hepatologists, ID doctors, and surgeons. A few highlights:

  • Jai Radhakrishnan from Columbia University explained that HCV is most often associated with immune-mediated cryoglobulinemic vasculitis and MPGN
  • Raymond Chung from MGH spoke about the rapidly changing landscape of HCV drugs. He went over some of the most important clinical trials (COSMOS, ION-2, SAPPHIRE, TURQUOISE-II, ALLY-3).  The bottom line is HCV medications are continuing to change quickly and we should be consulting the HCV Guidelines website frequently.
  • Alysse Wurcel, my medical school classmate, who is now an ID doctor at Tufts, spoke about cotreatment of HIV/HCV. She made a number of important points, but one that I particularly agreed with was the importance of intensive follow-up with these patients and open discourse about drug and alcohol use. Substance use can be a barrier to achieving an SVR and can get in the way of HIV viral suppression, and the physician-patient relationship is key.
  • Meghan Sise talked about cryoglobulinemic glomerulonephritis in the context of HCV
  • Craig Gordon, a nephrologist from BMC, spoke about HCV treatment and ESRD
  • I’ve blogged previously about Hepatitis C/ HIV coinfection and the general messages remain the same. These treatments are potentially life saving if they can lead to SVR and prevent the sequellae of cirrhosis but they remain very expensive. This field of Hepatitis C is rapidly changing and will be getting only more complicated in the future. Just remembering the names of these medications is a challenge. It’s making learning Korean look easy!
Alysse Wurcel's conclusions
Alysse Wurcel’s “take home points” slide

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