Authors: Khalid Alsaran Alaa Sabry Naila Shaheen
Publish Date: 2010/05/19
Volume: 43, Issue: 3, Pages: 865-873
Abstract
Chronic hepatitis C infection is common among patients on dialysis While the associated liver disease is usually relatively mild during dialysis disease progression can accelerate due to immunosuppression following kidney transplantation and interferon therapy after transplantation stimulates graft rejection Pegylated interferon and ribavirin are now the recommended treatment for chronic hepatitis C virus in patients without renal failure However until now there has been relatively little information on the efficacy and tolerability of pegylated interferon in dialysis patientsThis controlled study included 28 patients with endstage renal disease who had been on dialysis in the Prince Salman Center for Kidney Disease for more than 6 months and tested positive for HCV RNA on repeated occasions Thirteen patients were treated with pegylated interferon alpha2a therapy of which three were also receiving ribavirin and the remaining fifteen served as controls Viral genotyping and both qualitative and quantitative PCR were carried out before starting therapy Treatment was continued for 48 weeks After 24 weeks of treatment the biochemical and virological responses were evaluated Biochemical response was evaluated at the end of the treatment with sustained virological response SVR being evaluated 24 weeks later The side effects were monitored throughout the treatment periodAll patients in the treatment group completed 48 weeks of therapy without any drop out Their mean age was 4338 ± 1162 years After 24 weeks of therapy 10 patients 76 were initial responders while 3 patients 24 were resistant Six months after termination of therapy 9 patients 69 were sustained responders while one patient relapsed Their ALT and AST dropped from 5578 ± 3379 IU/dl and 3404 ± 1958 IU/dl before starting therapy to 2722 ± 1654 IU/dl and 1888 ± 1228 IU/dl after termination P = 06 and 08 respectively Their mean hemoglobin Hb level dropped from 1105 ± 143 to 948 ± 124 g/dl P = 03 and white blood cell count WBC dropped from 682 ± 26 × 103/mm3 to 41 ± 234 × 103/mm3 P = 057 Platelet count fell from 19456 ± 12978 × 103/mm3 to 15233 ± 10766 × 103/mm3 P = 039 When initial responders n = 10 were compared to resistant patients n = 3 the only observable difference was higher ALT and AST levels in resistant patients Pegylated interferon alpha2a was well tolerated and none of the patients stopped interferon because of hematological side effects while dose modification was carried out in most of the patients All three patients who received combination therapy from the start were sustained responders None of the patients in the control group seroconverted to HCV negative status during the study periodPegylated interferon alpha2a was well tolerated among our hemodialysis patients Hematological disturbances appeared to be the most important adverse effects At the end of therapy a response rate of up to 76 with 69 sustained response can be obtained with pegylated interferon alpha2a therapy
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