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

Conclusions

HCV infection still remains a major health problem that can cause substantial liver-related morbidity and mortality in patients with ESRD. Universal precautions against nosocomial blood-borne infections, routine ALT, and anti-HCV surveillance should be strictly adhered to in order to prevent and detect acute HCV infection. Conventional and pegylated IFN monotherapy are both effective and safe for the treatment of ESRD patients with acute hepatitis C. Careful surveillance of serum HCV-RNA levels during the first 16 weeks of acute hepatitis C is helpful AS to avoid unnecessary therapy for the small proportion with acute, self-limiting hepatitis C.

Approximately one-third of ESRD patients with chronic hepatitis C treated with conventional or pegylated IFN monotherapy achieve an SVR. The combined use of low-dose ribavirin plus conventional or pegylated IFN can further increase the SVR rates for treatment-naïve or treatment-relapse (after conventional or pegylated IFN monotherapy) ESRD patients with chronic hepatitis C by improving on-treatment viral suppression and reducing off-treatment relapse. However, close monitoring of hemoglobin levels and high-dose erythropoietin are needed to prevent severe anemia during the treatment period. Determination of pretreatment serum HCV-RNA levels, HCV genotype, and stage of hepatic fibrosis, as well as the monitoring of on-treatment serum HCV-RNA kinetics, are recommended to guide the optimal therapy.

IFN-based therapy is generally not recommended for treating HCV infection after RT because it might cause graft dysfunction or loss. The beneficial effects on sustained viral suppression, biochemical remission, histological improvement, and quality of life can be maintained in patients with an SVR either during dialysis or after RT. Most IFN-based therapeutic studies for ESRD patients with HCV infection are too small to adequately address safety and efficacy issues, and the long-term outcome of ESRD patients with HCV infection after IFN-based therapy remains unclear. Large-scale, well-conducted studies are necessary to answer these interesting and important issues.

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