Treatment of HCV in patients with renal failure.

Division of Gastroenterology, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA.
Archives of Medical Research (Impact Factor: 2.41). 09/2007; 38(6):628-33. DOI: 10.1016/j.arcmed.2006.12.010
Source: PubMed

ABSTRACT There continues to be a high prevalence of hepatitis C virus infection in patients with chronic kidney disease (CKD) on maintenance hemodialysis, despite screening of blood products and precautions to prevent the transmission of viral hepatitis within dialysis units. In addition, an increased rate of mortality from liver disease has been observed in infected patients on long-term dialysis, despite the frequent absence of biochemical dysfunction. Hepatitis C-infected renal transplant recipients have diminished patient and graft survivals compared to uninfected controls. Treatment with interferon in renal transplant candidates has resulted in sustained viral responses that have been long lasting even after subsequent renal transplant. A major concern limiting the use of interferon following renal transplant is graft dysfunction due to rejection. Ribavirin's induction of hemolytic anemia is the major reason why it is avoided in patients with CKD. Cautious use of reduced-dose ribavirin in small studies has been promising in these patients with close monitoring of hematocrit and additional measures to enhance compensatory erythropoiesis.

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    ABSTRACT: Background and Aims: Only few small studies have evaluated efficacy of ribavirin in combination with pegylated interferon or standard interferon in hemodialysis patients. In current review, we aim to determine
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    ABSTRACT: Key Principles “Special” HCV-infected populations are those in whom specific aspects relating to the clinical presentation, diagnosis, and/or treatment can be identified and targeted to improve the health of a patient and a population. The populations described in this chapter include the following: those co-infected with the human immunodeficiency virus (HIV)/hepatitis B virus (HBV), specific ethnic groups (Latinos/African Americans), those with insulin resistance and those with chronic kidney disease. Approximately 30% of those infected with HIV have concomitant HCV. HIV appears to accelerate the progression of HCV. The standard of care in this population is pegylated interferon and ribavirin. All patients in whom the potential benefit of therapy outweighs its risk should be offered therapy. HBV co-infection is unusual but may cause hastened disease progression in HCV. Treatment options would depend on which viral infection is believed to predominate. Ethnic differences exist in the epidemiology, natural history, and treatment responses of HCV in Latinos and African Americans. Latinos infected with hepatitis C are more likely to be males, co-infected with HIV, and have acquired HCV at a younger age compared to Caucasians. The Latino population has a lower chance of SVR compared to Caucasians. Multiple studies show a slower progression of liver disease in African Americans, who also have a lower chance of response to peg-IFN + RBV therapy compared to Caucasians. There is an increased prevalence of insulin resistance and diabetes in HCV. Patients with insulin resistance and diabetes in chronic HCV have more severe liver disease and decreased response to treatment compared to the general population. There is a higher prevalence of HCV infection in patients with chronic kidney disease (CKD), especially in those on hemodialysis (HD), than in the general population. Interferon-based therapy does produce comparable response rates to those with preserved renal function, but there is lower tolerability to therapy and a high dropout rate. When evaluating a member of a special population, efforts should be made to customize treatment both to the patient and to the virologic response in order to maximize chances of success.
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