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Hepatitis C virus infection and the dialysis patient
Fabrizio Fabrizi1, Giovanna Lunghi, Sri Venkatesh Ganeshan
1Division of Nephrology, Maggiore Hospital, IRCCS, Milan, Italy. fabrizi@policlinico.mi.it
Insights
Hepatitis C virus (HCV) is common in dialysis patients, impacting liver health and survival. While interferon therapy shows promise, its use requires careful consideration, especially post-renal transplant.
Area of Science:
- Nephrology
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) infection is prevalent in patients undergoing dialysis, posing a significant risk for liver disease.
- Nosocomial spread remains a primary route of HCV acquisition in dialysis settings, despite blood product screening.
- HCV infection negatively impacts the survival rates of patients with chronic kidney disease on dialysis.
Purpose of the Study:
- To review the current understanding of Hepatitis C virus in dialysis patients.
- To explore treatment options for HCV in this population, including interferon-based therapies.
- To assess the implications of pre-renal transplant HCV treatment on post-transplant outcomes.
Main Methods:
- Literature review of clinical trials and observational studies on HCV in dialysis patients.
- Analysis of treatment efficacy and tolerance of interferon-based therapies.
- Evaluation of outcomes following renal transplantation in patients with a history of HCV infection.
Main Results:
- Dialysis patients may have higher response rates but lower tolerance to conventional interferon therapy.
- Limited data exist on pegylated interferon and ribavirin for HCV in dialysis patients.
- Pre-renal transplant antiviral therapy shows durable responses and potential benefits post-transplant.
Conclusions:
- HCV management in dialysis patients requires tailored approaches due to unique challenges in efficacy and tolerance.
- Successful pre-transplant HCV treatment may improve post-renal transplant outcomes, reducing complications like diabetes and glomerulonephritis.
- Further research is needed on optimal antiviral strategies for HCV in the dialysis population, particularly with newer agents.
Abstract:
Hepatitis C virus (HCV) remains common in patients undergoing regular dialysis and is an important cause of liver disease in this population both during dialysis and after renal transplantation (RT). Anti-HCV screening of blood products has almost eliminated posttransfusion HCV infection but acquisition of HCV continues to occur in dialysis patients because of nosocomial spread. The natural history of HCV in dialysis population is not completely understood though recent data show that HCV infection has a detrimental role on survival of chronic dialysis patients. Several clinical trials have suggested that the response rate to conventional interferon (IFN) is higher in dialysis patients than those with normal kidney function but tolerance is lower. There are only limited data about pegylated IFN alone or in association with ribavirin for hepatitis C in dialysis population. IFN remains contraindicated post-RT because of concern about precipitating graft dysfunction; however, preliminary evidence shows the durability of sustained response to antiviral therapy pre-RT after renal transplant. Successful pretransplant therapy is associated with several benefits after RT including reduced incidence of posttransplant diabetes mellitus and de novo glomerulonephritis in HCV-infected recipients.
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