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

Chen-Hua Liu 1,2,3, Jia-Horng Kao 1,2,3,*

Journal of Gastroenterology and Hepatology
Accepted Article (Accepted, unedited articles published online for future issues)
DOI: 10.1111/j.1440-1746.2010.06488.x
Journal compilation © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd

Author Information

1 Department of Internal Medicine,
2 Hepatitis Research Center, and
3 Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan

*Correspondence: Jia-Horng Kao,

*Correspondence: Prof. Jia-Horng Kao Director and Distinguished Professor, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine 1 Chang-Te St., Taipei 10002, Taiwan Tel.: 886-2-23123456 ext 67307 Fax: 886-2-23825962 E-mail: kaojh@ntu.edu.tw

Publication History
Accepted manuscript online: 17 AUG 2010 12:21PM EST
Received date: 1-Aug-2010 Accepted date: 8-Aug-2010


Keywords:
hepatitis C virus;end-stage renal disease;dialysis;interferon;ribavirin

Abstract

Hepatitis C virus (HCV) infection is a major health problem in patients with end-stage renal disease (ESRD). The incidence of acute HCV infection during maintenance dialysis is much higher than that in the general population because of the risk of nosocomial transmission. Following acute HCV infection, most develop chronic HCV infection; a significant proportion develops chronic hepatitis, cirrhosis, and even hepatocellular carcinoma (HCC). Overall, chronic hepatitis C patients on hemodialysis bear an increased risk of liver-related morbidity and mortality, either during dialysis or after renal transplantation. Interferon (IFN) therapy is modestly effective for the treatment of HCV infection in ESRD patients. Conventional or pegylated IFN monotherapy has been used to treat acute hepatitis C in ESRD patients with excellent safety and efficacy. Regarding chronic hepatitis C, about one third of the patients can achieve sustained virologic response (SVR) after conventional or pegylated IFN monotherapy. The combination of low-dose ribavirin and conventional of pegylated IFN has further improved the SVR rate in treatment-naïve or retreated ESRD patients in clinical trials. Similar to treatment of patients with normal renal function, baseline and on-treatment HCV virokinetics are useful to guide optimized therapy in ESRD patients. Of particular note, IFN-based therapy is not recommended at the post-renal transplantation stage because of the low SVR rate and risk of acute graft rejection. In conclusion, ESRD patients with HCV infection should be encouraged to receive antiviral therapy and those who achieve SVR usually have long-term durable virologic, biochemical, and histologic responses.

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