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: 2.65).
09/2007; 38(6):628-33. DOI: 10.1016/j.arcmed.2006.12.010
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.
Available from: PubMed Central
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ABSTRACT: Patients with chronic hepatitis C virus (HCV) infection and disease-related complications - among them cirrhosis and liver failure - pose a particular management challenge. Some of these patients may fail to respond to current therapy (non-responders), and some are affected so severely that treatment puts them at an unacceptable risk for complications. Treatment with pegylated interferon (peg-IFN) plus ribavirin improves hepatic enzyme levels and eradicates the virus in approximately 50% of patients; however, a significant number of patients do not respond to therapy or relapse following treatment discontinuation. Several viral, hepatic and patient-related factors influence response to IFN therapy; many of these factors cannot be modified to improve long-term outcomes. Identifying risk factors and measuring viral load early in the treatment can help to predict response to IFN therapy and determine the need to modify or discontinue treatment. Retreatment options for patients who have failed therapy are limited. Retreatment with peg-IFN has been successful in some patients who exhibit an inadequate response to conventional IFN treatment, particularly those who have relapsed. Consensus IFN, another option in treatment-resistant patients, has demonstrated efficacy in the retreatment of non-responders and relapsers. Although the optimal duration of retreatment and the benefits and safety of maintenance therapy have not been determined, an extended duration is likely needed. This article reviews the risk factors for HCV treatment resistance and discusses the assessment and management of difficult-to-treat patients.
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ABSTRACT: Hepatitis C virus (HCV) is the most common pathogen leading to serious morbidity and mortality in hemodialysis patients. The prevalence of HCV infection detected in dialysis patients in developing countries such as Turkey is generally much higher than those in developed countries. The prevalence of HCV infection among hemodialysis patients has been reported between 31.4% to 51% in Turkey. Interferon based therapy is the mainstay of treatment for HCV related liver disease in dialysis patients however, it is not recommended after renal transplantation because of the risk of acute rejection and graft dysfunction. Therefore it is important to eradicate HCV-RNA before transplantation. Currently available pegylated interferons have much higher efficacy against HCV than conventional interferons in the dialysis patients. Pegylation delays clearence of interferon and it leads to a more potent and longer antiviral effect. Two pegylated interferon (Peg-IFN) formulations with different pharmacokinetic characteristics are currently available (Peg-IFN alpha-2a and Peg-IFN alpha-2b). In view of the high prevalence of adverse effects associated with Peg-IFN, an increased awareness of their use in dialysis patient population is reasonable. However, there are few published studies on interferon therapy in hemodialysis patients. These studies confirm that the response rate to different interferon formulations is much higher than the general population but with a higher rate of adverse events. Ribavirin is usually not recommended in patients with chronic renal failure since the drug is not removed during conventional dialysis and its accumulation causes a dose dependent hemolytic anemia. Use of ribavirin plus interferons should still be limited to controlled clinical studies. Results obtained in recent clinical trials should be confirmed by large prospective, randomized, multi-center studies. In this review article the treatment of hemodialysis patients with chronic hepatitis C has been discussed under the light of recent literature.
Available from: Seyed Moayed Alavian
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