Interferon treatment for hepatitis C virus infection in patients on haemodialysis

BACKGROUND: This study examined the efficacy and tolerability of interferonalpha-2b (IFN) in the treatment of chronic hepatitis C virus (HCV)infection in patients on maintenance haemodialysis. METHODS: A 24- monthprospective cohort study was performed in 11 HCV RNA-positive haemodialysispatients, who were treated with IFN at 3 MU thrice weekly for 6 months.Serial biochemical and virological monitors included serum alanineaminotransferase levels, and HCV RNA by both qualitative PCR assay andquantitative bDNA assay. HCV genotypes were determined by PCR andnucleotide sequencing. Ten patients had baseline liver biopsy. RESULTS: HCVgenotypes 1b and 2b were identified in 10 and one patients respectively.Six (55%) patients had biochemical and/or histological features of chronicactive hepatitis before treatment. All 11 patients became HCV RNA-negativeby PCR, with normalization of deranged aminotransferase levels, within 2-8weeks of IFN therapy. HCV RNA reappeared in eight (73%) patients 2-8 weeksafter the cessation of IFN, while biochemical relapse occurred in six (55%)patients. Sustained eradication of HCV was achieved in three (27%)patients. Sustained responders were characterized by pretreatment HCV RNAlevel < 3.5 x 10(5) Eq/ml as determined by the bDNA assay, and lesssevere histological abnormalities ('Total score' 1.7 +/- 1.2 compared to5.4 +/- 2.2 in relapsers, P < 0.05). HCV RNA levels were similar beforeand after IFN treatment in non-responders and relapsers. Persistent malaiseand poor appetite were noted in eight (73%) patients during IFN therapy.Other side-effects of IFN included the exacerbation of anaemia, inductionof resistance to erythropoietin, weight loss, and reduced serum albuminlevel. CONCLUSIONS: Eradication of chronic HCV infection with IFN can beachieved in 27% of haemodialysis patients. Predictors of sustained responseinclude low baseline HCV RNA level and mild liver pathology. Virologicalrelapse can occur despite normal liver biochemistry. Exacerbation ofanaemia, erythropoietin resistance, and malnutrition constitute theside-effects of IFN that deserve special attention in uraemic subjects.