Treatment of hepatitis C in dialysis patients

Abstract

Chronic infection with hepatitis C virus (HCV) is a major problem affecting a significant percentage of patients with end-stage renal failure (ESRD), with a negative impact on patient survival, and associated with accelerated progression of liver damage after undergoing a kidney transplant. After acute HCV infection, HCV infection becomes chronic in around 80% of patients and progresses to cirrhosis in about 20% of cases at 20 years of evolution. Treatments with interferon (IFN-α2a) and pegylated IFN are currently the only treatments that achieve a cure rate of about 30-45% of ESRD patients with chronic HCV infection. The combination with ribavirin (RBV) in the general population has improved the results, with a sustained virological response between 50% (genotype 1 and 4) and 80% (genotype 2 and 3); however, the poor tolerance to RBV in ESRD patients makes this treatment difficult in dialysis patients. Indication of antiviral treatment in HCV-positive patients on dialysis should be individualized. All HCV-positive candidates for kidney transplantation should be assessed to receive antiviral treatment before transplantation given the increased life expectancy compared to other HCV-positive patients on dialysis, the increased risk of progression of liver disease with immunosuppressive therapy and the inability to receive IFN therapy after renal transplantation.