title: Anti-viral therapy in haemodialysed HCV patients: efficacy, tolerance and treatment strategy.
abstract: BACKGROUND
  In end-stage renal disease (ESRD) patients, hepatitis C virus (HCV) eradication improves patient and graft survival.
  
  
  OBJECTIVE
  To determine optimal use of erythropoietin (EPO) and ribavirin, to compare ribavirin concentrations with those of HCV patients having normal renal function and to evaluate sustained virological response (SVR) in a prospective observatory of ESRD candidates for renal transplantation.
  
  
  METHODS
  Thirty-two naïve patients were treated with Peg-IFN-α2a and ribavirin. Two different schedules of ribavirin and EPO administration were used: starting ribavirin at 600mg per week and adapting EPO when haemoglobin (Hb) fell below 10g/dL (adaptive strategy) or starting ribavirin at 1000mg per week while increasing EPO from the start of treatment (preventive strategy).
  
  
  RESULTS
  Patients treated with the adaptive strategy had lower median Hb levels (9.6 vs. 10.9g/dL, P=0.02) and more frequent median Hb levels below 10g/dL (58 vs. 5%, P=0.0007) despite lower median ribavirin doses (105 vs. 142mg/day, P<0.0001) than patients treated with the preventive strategy. There was a trend for more frequent transfusion in patients treated with the adaptive strategy than in patients treated with preventive strategy (50 vs. 20%, P=0.08). Compared to patients with normal renal function, ESRD patients had lower ribavirin concentrations during the first month (0.81 vs. 1.7mg/L, P=0.007) and similar concentrations thereafter. SVR was reached in 50%.
  
  
  CONCLUSIONS
  Pegylated interferon (Peg-IFN) and an adapted schedule of ribavirin are effective in ESRD patients. Increasing EPO from the start of treatment provides better haematological tolerance. The optimal dosage of ribavirin remains unresolved, in light of frequent side effects.
authors.affiliation: CHU Lille, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Deltenre
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.forename: A
authors.initials: A
authors.lastname: Tran
authors.forename: I
authors.initials: I
authors.lastname: Ollivier
authors.forename: F
authors.initials: F
authors.lastname: Provôt
authors.forename: F
authors.initials: F
authors.lastname: Stanke
authors.forename: M
authors.initials: M
authors.lastname: Lazrek
authors.forename: H
authors.initials: H
authors.lastname: Castel
authors.forename: V
authors.initials: V
authors.lastname: Canva
authors.forename: A
authors.initials: A
authors.lastname: Louvet
authors.forename: M
authors.initials: M
authors.lastname: Colin
authors.forename: F
authors.initials: F
authors.lastname: Glowacki
authors.forename: S
authors.initials: S
authors.lastname: Dharancy
authors.forename: J
authors.initials: J
authors.lastname: Henrion
authors.forename: M
authors.initials: M
authors.lastname: Hazzan
authors.forename: C
authors.initials: C
authors.lastname: Noel
authors.forename: P
authors.initials: P
authors.lastname: Mathurin
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a