Hepatitis C in hemodialysis patients

Abstract

Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the "silent" clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the "beneficial" impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of "hepatoprotective" cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking.

Seroprevalence of HCV Infection Among Patients in a Tertiary Care Hospital in Bangalore

“…As seen in Figure-3, our study showed raised AST and ALT levels among three HCV positive haemodialysis patients and ten HCV positive non-haemodialysis patients which is in consensus with other studies such as Fabrizio [24] and Marinaki et al [27] Haemodialysis patients with chronic hepatitis due to HCV infection have serum aminotransferase levels which are at the upper limit but still within the normal range, although higher compared to HCV negative haemodialysis patients. There is no definite explanation regarding the lower transaminase levels observed in haemodialysis patients, although several aetiologies have been postulated-1.…”

Inflammatory Biomarkers and Liver Histopathology in Non-Uremic and Uremic Chronic Hepatitis C Patients

“…Important risk factors for HepC are blood transfusions, solid organ transplantation from an infected donor, i.v. drug use, non-safe therapeutic injections, occupational percutaneous exposures and familial or dialysis-related exposures (3)(4)(5). Despite the fact that HepC incidence and prevalence have declined in the last years, mainly in the hemodialysis population, it is still a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma (1,2,5).…”

Virological response to daclatasvir and asunaprevir combination therapy for chronic hepatitis C virus genotype 1b infection in dialysis patients: a prospective, multicenter study

“…It is well known that the predominant cause of death in patients on regular dialysis is cardiovascular, and sudden cardiac death frequently occurs in CKD patients [28]. HCV infection in patients undergoing HD was also reported as a cardiovascular risk factor [29,30]. We need to consider that HCV patients on dialysis have a high risk of sudden death due to cardiac disease during combination therapy.…”