CHRONIC NON-A, NON-B-HEPATITIS COMPLICATED BY END-STAGE RENAL-FAILURETREATED WITH RECOMBINANT INTERFERON-ALPHA

Chronic non-A, non-B hepatitis occurs in 50% of Saudi patients with en d-stage renal failure and requires long-term hemodialysis since it is a contraindication to renal transplantation. Thirteen patients with bi ochemical and histological documented chronic non-A, non-B hepatitis ( 11 with HCV antibodies) entered a double-blind placebo controlled cros s-over study, in which Roferon A 3 MU or placebo were administered sub cutaneously 3 times weekly after hemodialysis for 6 months. The mean A LT fell significantly from pretreatment levels of 74.7 (95% confidence interval (CI) 54.7, 92.5) (13 patients in the 6-month run-in period) and 66.8 (CI 47.7, 85.8) (7 patients in the run-in period + 6 patients in the placebo period) (difference NS) to 37.6 (CI 21.0, 54.2) during interferon treatment (P < 0.005). In 10/13 patients (77%) ALT levels became normal. In the 6-month follow-up period immediately after thera py, the mean ALT was 45.2 (CI 28.0, 62.0). Although this change was no t significant (P = 0.49), only 7 of these 10 patients sustained bioche mical remission in the 6-month follow-up period. The corresponding tot al Histological Activity Index improved from 8.9 (CI 7.5, 10.3), 8.9 ( CI 7.2, 10.7) (difference NS) to 6.2 (CI 3.9, 8.5) (P < 0.05; P = 0.05 2, respectively). Intralobular inflammation and periportal inflammatio n showed the most significant changes. Five of 13 (39%) and 2/13 patie nts (15%) had complete resolution of piecemeal necrosis and intralobul ar inflammation, respectively. Toxic effects of interferon were mild, early and self-limiting. Interferon is effective in controlling bioche mical and histological manifestation of chronic non-A, non-B hepatitis complicating endstage renal failure in Saudi patients on long-term ma intenance haemodialysis.