Nephrol Dial Transplant (1999) 14: 2704-2709
© 1999 European Renal Association-European Dialysis and Transplant Association
Efficacy and tolerance of interferon-
2b in the treatment of chronic hepatitis C virus infection in haemodialysis patients. Pre- and post-renal transplantation assessment
1 Renal Transplant Unit, 2 Microbiology Department and 3 Hepatology Department, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, 4 Fundació Puigvert, Barcelona, 5 Hospital Arnau de Vilanova, Lleida, 6 CETIRSA, Terrassa, 7 Centre Hospitalari i Cardiologic, Manresa, 8 IMB, Barcelona, 9 CETIRSA, Barcelona, 10 Hospital de Terrassa, Terrassa, 11 Clinica Girona, Girona and 12 Hospital de la Creu Roja, Barcelona, Spain
Correspondence and offprint requests to: J. M. Campistol, MD, Renal Transplant Unit, Hospital Clinic, 170, Villarroel, 08036 Barcelona, Spain.
Background. Hepatitis C virus (HCV) infection represents an important problem for the dialysis population due to its high prevalence and the long-term development of chronic liver disease, particularly following renal transplantation.
Methods. In order to assess the efficacy and tolerance of interferon (IFN) in the treatment of chronic hepatitis C in haemodialysis (HD) patients and their clinical course following renal transplantation, a multicentre, randomized, open-label study was conducted to compare IFN therapy vs a control group.
Results. Nineteen HCV RNA-positive patients received 3x106 U of IFN s.c., three times a week (post-HD), and 17 HCV RNA-positive patients were assigned to the control group. Tolerance to IFN therapy was good in nine patients, while treatment was discontinued in the other 10 due to the occurrence of side effects. HCV RNA was negative at the end of treatment in 14 out of 19 patients (74%) receiving IFN and in one patient (5%) in the control group. Six out of the 14 patients who initially responded to IFN therapy had a virological relapse (43%). Eight patients (42%) remained HCV RNA-negative, three of them until the day that renal transplantation (RT) was performed (7, 12 and 27 months, respectively), as did five patients on HD during the follow-up (27±5 months). Eight out of the nine patients (89%) who completed therapy were HCV RNA-negative at the end of treatment, and seven of them (78%) remained HCV RNA-negative during the follow-up on dialysis (21±8 months). Mean transaminase (ALT) values were significantly decreased following IFN therapy, while no changes were observed during the follow-up period in the control group. Fifteen patients (10 in the treatment group and five in the control group) underwent RT. Three patients in the treatment group were HCV RNA-negative at RT, and one of them had a virological relapse 20 months after RT, while the other two remained HCV RNA-negative at 3 months and 24 months after RT, respectively. In contrast to the control group, transaminase (ALT) remained within normal limits in all patients in the treatment group. Finally, during the post-RT follow-up, the transaminase mean values were significantly lower in treated patients vs patients in the control group (P<0.05).
Conclusions. It is concluded that the biochemical and virological response to IFN therapy is good in HD patients. In addition, IFN therapy appears to exert a beneficial effect on the course of liver disease following RT, regardless of the virological response. Despite the fact that IFN therapy was discontinued in 10 out of the 19 patients due to the occurrence of side effects, these disappeared following discontinuation of therapy. Therefore, IFN therapy is advisable for HCV-infected dialysis patients who are candidates for RT.
Keywords: hepatitis C virus; interferon; haemodialysis; renal transplantation
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