American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with stage 5 chronic kidney disease and hepatitis C, which combination of drugs is recommended for treatment?

1. Ribavirin and interferon

2. Grazoprevir and elbasvir

3. Sofosbuvir and ledipasvir

4. Boceprevir and telaprevir

The correct answer is: Grazoprevir and elbasvir

In patients with stage 5 chronic kidney disease and hepatitis C, the recommended combination of drugs is grazoprevir and elbasvir. This is due to the fact that these agents are direct-acting antiviral (DAA) medications specifically indicated for the treatment of hepatitis C. This combination is beneficial in patients with significant renal impairment, including those with end-stage renal disease. Grazoprevir, an NS3/4A protease inhibitor, works effectively against hepatitis C virus (HCV) genotype 1 and 4, while elbasvir is an NS5A inhibitor that is effective against HCV genotype 1. Together, they provide a potent therapeutic option that can achieve high rates of sustained virologic response (SVR) in these patients. The other combinations listed do not align with current treatment recommendations for patients with severe renal disease. Ribavirin and interferon, despite being historical treatments for hepatitis C, are no longer preferred due to their adverse effect profiles and lower effectiveness compared to newer DAAs. Sofosbuvir and ledipasvir, although effective, are not recommended in patients with severe renal impairment, as sofosbuvir is contraindicated in this population due to the risk of accumulation. Bocepre