Treatment of Hepatitis C Virus Infection in Patients with End-stage Renal Disease

Chen-Hua Liu; Jia-Horng Kao

Disclosures

J Gastroenterol Hepatol. 2011;26(2):228-239. 

In This Article

Treatment of ESRD Patients with Acute HCV Infection

IFN Monotherapy

IFN-α monotherapy has been used successfully to treat non-uremic patients with acute hepatitis C. Treatment with conventional IFN at a dose of 3–6 million units (MU) three times per week for 4–24 weeks had an overall SVR rate of 32–98%.[94–96] In ESRD patients with acute hepatitis C, the overall SVR rate in patients who received conventional IFN at a dose of 3–10 MU three times per week for 12–48 weeks was 26–86%, which was higher than those who did not receive IFN therapy (5.6–12.5%) (Table 3).[97–101] The treatment-related withdrawal rate was 0–22%, depending on different treatment dosages and durations. Patients who received a higher dose of IFN and had a lower HCV E1/NS1 single-strand conformational polymorphism band number were predictive of SVR.[98,101]

Pegylated IFN Monotherapy

The use of pegylated IFN-α-2b at a dose of 1–1.66 μg/kg/week for 12–24 weeks further increased the SVR rate to 82–95% in non-uremic patients with acute hepatitis C.[103,104] However, there have been a few studies that have evaluated the safety and efficacy of pegylated IFN for ESRD patients with acute hepatitis C. Engel et al. identified 32 ESRD patients with acute hepatitis C, 10 of whom received pegylated IFN-α-2b at a dose of 1 μg/kg/week for 24 weeks. The SVR rate was 40%, and one of the 10 treated patients died during the treatment because of pneumonia and fistula formation.[102] In 2008, we evaluated 35 such patients, all of whom received pegylated IFN-α-2a at a dose of 135 μg/week for 24 weeks. The SVR rate in the treated patients was 89%, which was significantly higher than those of the non-treatment historical controls (17%); the premature withdrawal rate was 5.7%.[4] Among patients who received 80% of the scheduled treatment dosage and duration, the SVR rate was 90%. In contrast, baseline ALT levels, HCV-RNA levels, and the genotype did not influence SVR. A 16-week HCV-RNA surveillance rule after the onset of acute hepatitis C is ideal to determine the necessity of IFN treatment in this situation.[4]

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