EFFECTIVENESS AND TOLERANCE OF INTERFERON-ALPHA-2B IN THE TREATMENT OF CHRONIC HEPATITIS-C IN HEMODIALYSIS-PATIENTS

Twenty-five per cent of haemodialysed patients carry anti-HCV antibodi es; these antibodies are associated with detectable viraemia in 85% an d chronic hepatitis in 90% of subjects, despite normal transaminases i n more than half of them. This underlines the importance of antiviral therapy. We evaluated the tolerance and effectiveness of a classic int erferon (IFN) treatment (3 MU three times a week for 6 months, subcuta neously) in 19 haemodialysis patients presenting with anti-HCV antibod ies and chronic (n = 16) or acute (n = 3) hepatitis. Thirteen of those 19 patients had elevated transaminases. Viraemia C was detected by ge nome amplification (PCR) and by the bDNA test before and after interfe ron therapy as well as 6 months at least after the end of INF treatmen t. Response (defined as liver enzyme normalization) was noted in 11 (8 4.6%) of the 13 patients with elevated transaminases; at the end of fo llow-up, six exhibited long-term response and five had relapsed, HCV-R NA was detected in 15 of the 19 patients before IFN therapy and remain ed positive in 7/15 initially viraemic patients at the end of treatmen t. Hepatitis C RNA was detected at the last follow-up visit (mean foll ow-up duration 18+/-9 months) in 12 of the 15 initially viraemic patie nts. Liver histology was improved in most patients, regardless of thei r biological response. One patient could not complete the 6-month cour se because of clinical and haematological adverse events. In the six p atients with strictly normal transaminases, HCV RNA was detectable in 4/6 patients before treatment, in 2/4 viraemic patients at the end of treatment, and in 4/4 at the last follow-up visit. All pathological si gns disappeared in four of the five patients who had no detectable HCV -RNA before IFN therapy. To conclude: (i) interferon-alpha exhibits sa tisfactory effectiveness and tolerance in haemodialysed patients; (ii) HCV replication recurs in most of these patients despite histological improvement; (iii) interferon-alpha can be effective even in patients with chronic hepatitis and no detectable HCV-RNA.