Efficacy and tolerance of interferon-alpha(2b) in the treatment of chronichepatitis C virus infection in haemodialysis patients. Pre- and post-renaltransplantation assessment

Background. Hepatitis C virus (HCV) infection represents an important probl em for the dialysis population due to its high prevalence and the long-term development of chronic liver disease, particularly following renal transpl antation. 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, rando mized, open-label study was conducted to compare IFN therapy vs a control g roup. Results. Nineteen HCV RNA-positive patients received 3x10(6) U of IFN s.c., three times a week (post-HD), and 17 HCV RNA-positive patients were assign ed 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 vi rological relapse (43%). Eight patients (42%) remained HCV RNA-negative, th ree 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 foll ow-up (27+/-5 months). Eight out of the nine patients (89%) who completed t herapy 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 month s). Mean transaminase (ALT) values were significantly decreased following I FN therapy, while no changes were observed during the follow-up period in t he control group. Fifteen patients (10 in the treatment group and five in t he 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, transamin ase (ALT) remained within normal limits in all patients in the treatment gr oup. Finally, during the post-RT follow-up, the transaminase mean values we re 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 I-ID patients. In addition, IFN therapy appears t o exert a beneficial effect on the course of liver disease following RT, re gardless 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 ef fects, these disappeared following discontinuation of therapy. Therefore, I FN therapy is advisable for HCV-infected dialysis patients who are candidat es for RT.