[Treatment of chronic hepatitis C virus infection in hemodialysis patients]. 2008

Selçuk Kaya
Trabzon Numune Eğitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Trabzon. eselkaya@yahoo.com

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.

UI MeSH Term Description Entries
D007676 Kidney Failure, Chronic The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION. ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D011092 Polyethylene Glycols Polymers of ETHYLENE OXIDE and water, and their ethers. They vary in consistency from liquid to solid depending on the molecular weight indicated by a number following the name. They are used as SURFACTANTS, dispersing agents, solvents, ointment and suppository bases, vehicles, and tablet excipients. Some specific groups are NONOXYNOLS, OCTOXYNOLS, and POLOXAMERS. Macrogols,Polyoxyethylenes,Carbowax,Macrogol,Polyethylene Glycol,Polyethylene Oxide,Polyethyleneoxide,Polyglycol,Glycol, Polyethylene,Glycols, Polyethylene,Oxide, Polyethylene,Oxides, Polyethylene,Polyethylene Oxides,Polyethyleneoxides,Polyglycols,Polyoxyethylene
D011994 Recombinant Proteins Proteins prepared by recombinant DNA technology. Biosynthetic Protein,Biosynthetic Proteins,DNA Recombinant Proteins,Recombinant Protein,Proteins, Biosynthetic,Proteins, Recombinant DNA,DNA Proteins, Recombinant,Protein, Biosynthetic,Protein, Recombinant,Proteins, DNA Recombinant,Proteins, Recombinant,Recombinant DNA Proteins,Recombinant Proteins, DNA
D006435 Renal Dialysis Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION. Dialysis, Extracorporeal,Dialysis, Renal,Extracorporeal Dialysis,Hemodialysis,Dialyses, Extracorporeal,Dialyses, Renal,Extracorporeal Dialyses,Hemodialyses,Renal Dialyses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000075202 Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Contraindications, Physical Agent,Medical Contraindications,Agent Contraindication, Physical,Agent Contraindications, Physical,Contraindication,Contraindication, Medical,Contraindication, Physical Agent,Contraindications, Medical,Medical Contraindication,Physical Agent Contraindication,Physical Agent Contraindications
D000077190 Interferon alpha-2 Alpha interferon encoded by the human IFNA2 gene. Recombinant forms are used in the treatment of CHRONIC HEPATITIS B; CHRONIC HEPATITIS C; KAPOSI SARCOMA; MELANOMA; and HAIRY CELL LEUKEMIA. IFN-alpha 2,IFN-alpha-2,IFNalpha-2b, Recombinant,Interferon alfa-2a,Interferon alfa-2b,Interferon alpha-2b, Recombinant,Interferon alpha-A,Interferon-alpha 2,Intron A (Interferon),LeIF A,Reaferon,Recombinant Interferon alpha-2a,Recombinant Interferon alpha-2b,Ro 22-8181,Roferon-A,Sch-30500,Viferon,IFNalpha 2b, Recombinant,Interferon alfa 2a,Interferon alfa 2b,Interferon alpha 2,Interferon alpha 2b, Recombinant,Interferon alpha A,Interferon alpha-2a, Recombinant,Recombinant IFNalpha-2b,Recombinant Interferon alpha 2a,Recombinant Interferon alpha 2b,Ro 22 8181,Ro 228181,Roferon A,RoferonA,Sch 30500,Sch30500
D000998 Antiviral Agents Agents used in the prophylaxis or therapy of VIRUS DISEASES. Some of the ways they may act include preventing viral replication by inhibiting viral DNA polymerase; binding to specific cell-surface receptors and inhibiting viral penetration or uncoating; inhibiting viral protein synthesis; or blocking late stages of virus assembly. Antiviral,Antiviral Agent,Antiviral Drug,Antivirals,Antiviral Drugs,Agent, Antiviral,Agents, Antiviral,Drug, Antiviral,Drugs, Antiviral
D012254 Ribavirin A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. Ribovirin,Tribavirin,ICN-1229,Rebetol,Ribamide,Ribamidil,Ribamidyl,Ribasphere,Vilona,Viramide,Virazide,Virazole,ICN 1229,ICN1229
D014421 Turkey Country in Southeastern Europe and Southwestern Asia bordering the Black Sea, between Bulgaria and Georgia, and bordering the Aegean Sea and the Mediterranean Sea, between Greece and Syria. The capital is Ankara. Turkiye

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