Treatment of chronic hepatitis C in patients with end-stage renal disease and hemophilia--the Singapore experience.
OBJECTIVE
The aim of this study was to determine the response to treatment with interferon-alpha (IFN-alpha) in patients with chronic hepatitis C who had end-stage renal disease (ESRD) or hemophilia in Singapore.


METHODS
Treatment-naive hepatitis patients with ESRD or hemophilia were given IFN-alpha(2a) 3 million units three times per week for 12 months in an open-label study. Hepatitis C virus RNA was determined before treatment, at the end of treatment and 6 months thereafter. Regular clinical examinations including blood counts and biochemistry were carried out during and after the treatment.


RESULTS
Nine consecutive patients with ESRD (8 men and 1 woman) and 6 consecutive male patients with hemophilia, with a mean age of 43 and 40 years, received treatment. Patients in both groups were predominantly infected with hepatitis C virus genotype 1 and had significant cytopenia affecting all three cell lines during the treatment; only 1 patient developed serious neutropenia, temporarily demanding a reduction of his IFN dose. Biochemical and virological responses at the end of treatment were accomplished by 8 of the 9 (89%) patients with ESRD and 4 of the 6 (67%) patients with hemophilia; however, 1 patient with ESRD and 2 with hemophilia relapsed after the treatment. Four of the 7 patients with ESRD who had sustained virological response underwent successful kidney transplantation later on.


CONCLUSIONS
Monotherapy with IFN-alpha for 12 months is safe for treatment of the patients with chronic hepatitis C who had ESRD or those with hemophilia. A higher sustained virological response rate was observed in patients with ESRD than in those with hemophilia (78 vs. 33%).
Chow
Wan-Cheng
WC
Department of Gastroenterology, Singapore General Hospital, Outram Road, 169608 Singapore, Singapore. gm2cwc@sgh.com.sg
Tien
Sim-Leng
SL
Tan
Chee-Kiat
CK
Lui
Hock-Foong
HF
Vathsala
Anantharaman
A
Ng
Han-Seong
HS
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001772:Blood Cell Count; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D016174:Hepacivirus / Q000302:isolation & purification / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007279:Injections, Subcutaneous; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications*; D007970:Leukopenia / Q000209:etiology; D008297:Male; D011994:Recombinant Proteins; D012846:Singapore; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins