Treatment of hepatitis C in dialysis patients.
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.
Nuria
N
Esforzado
Josep Maria
JM
Campistol
D000998:Antiviral Agents / Q000627:therapeutic use*; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D006435:Renal Dialysis; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a