Treatment of chronic hepatitis C virus infection in hemodialysis patients

Hepatitis C virus (HCV) is the most common pathogen leading to serious morbidity and mortality in hemodialysis patients. The prevalence of HCV infection detected in dialysis patients in developing countries such as Turkey is generally much higher than those in developed countries. The prevalence of HCV infection among hemodialysis patients has been reported between 31.4% to 51% in Turkey. Interferon based therapy is the mainstay of treatment for HCV related liver disease in dialysis patients however, it is not recommended after renal transplantation because of the risk of acute rejection and graft dysfunction. Therefore it is important to eradicate HCV-RNA before transplantation. Currently available pegylated interferons have much higher efficacy against HCV than conventional interferons in the dialysis patients. Pegylation delays clearence of interferon and it leads to a more potent and longer antiviral effect. Two pegylated interferon (Peg-IFN) formulations with different pharmacokinetic characteristics are currently available (Peg-IFN alpha-2a and Peg-IFN alpha-2b). In view of the high prevalence of adverse effects associated with Peg-IFN, an increased awareness of their use in dialysis patient population is reasonable. However, there are few published studies on interferon therapy in hemodialysis patients. These studies confirm that the response rate to different interferon formulations is much higher than the general population but with a higher rate of adverse events. Ribavirin is usually not recommended in patients with chronic renal failure since the drug is not removed during conventional dialysis and its accumulation causes a dose dependent hemolytic anemia. Use of ribavirin plus interferons should still be limited to controlled clinical studies. Results obtained in recent clinical trials should be confirmed by large prospective, randomized, multi-center studies. In this review article the treatment of hemodialysis patients with chronic hepatitis C has been discussed under the light of recent literature.