Nephrology Dialysis Transplantation, Vol 12, Issue 7 1414-1419, Copyright © 1997 by Oxford University Press
TM Chan, PC Wu, JY Lau, AS Lok, CL Lai and IK Cheng
BACKGROUND: This study examined the efficacy and tolerability of interferon
alpha-2b (IFN) in the treatment of chronic hepatitis C virus (HCV)
infection in patients on maintenance haemodialysis. METHODS: A 24- month
prospective cohort study was performed in 11 HCV RNA-positive haemodialysis
patients, who were treated with IFN at 3 MU thrice weekly for 6 months.
Serial biochemical and virological monitors included serum alanine
aminotransferase levels, and HCV RNA by both qualitative PCR assay and
quantitative bDNA assay. HCV genotypes were determined by PCR and
nucleotide sequencing. Ten patients had baseline liver biopsy. RESULTS: HCV
genotypes 1b and 2b were identified in 10 and one patients respectively.
Six (55%) patients had biochemical and/or histological features of chronic
active hepatitis before treatment. All 11 patients became HCV RNA-negative
by PCR, with normalization of deranged aminotransferase levels, within 2-8
weeks of IFN therapy. HCV RNA reappeared in eight (73%) patients 2-8 weeks
after the cessation of IFN, while biochemical relapse occurred in six (55%)
patients. Sustained eradication of HCV was achieved in three (27%)
patients. Sustained responders were characterized by pretreatment HCV RNA
level < 3.5 x 10(5) Eq/ml as determined by the bDNA assay, and less
severe histological abnormalities ('Total score' 1.7 +/- 1.2 compared to
5.4 +/- 2.2 in relapsers, P < 0.05). HCV RNA levels were similar before
and after IFN treatment in non-responders and relapsers. Persistent malaise
and poor appetite were noted in eight (73%) patients during IFN therapy.
Other side-effects of IFN included the exacerbation of anaemia, induction
of resistance to erythropoietin, weight loss, and reduced serum albumin
level. CONCLUSIONS: Eradication of chronic HCV infection with IFN can be
achieved in 27% of haemodialysis patients. Predictors of sustained response
include low baseline HCV RNA level and mild liver pathology. Virological
relapse can occur despite normal liver biochemistry. Exacerbation of
anaemia, erythropoietin resistance, and malnutrition constitute the
side-effects of IFN that deserve special attention in uraemic subjects.
ORIGINAL ARTICLES
Interferon treatment for hepatitis C virus infection in patients on haemodialysis
University of Hong Kong, Queen Mary Hospital, Hong Kong.
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