Interferon for Hepatitis C Virus in Hemodialysis—an Individual Patient Meta-analysis of Factors Associated with Sustained Virological Response

Abstract

Background and objectives: Hepatitis C virus (HCV) infection is prevalent in hemodialysis patientsResults: Twenty studies of IFN treatment provided data on 428 patients. Overall SVR was 45% and in univariate analyses was higher with: 1) three million units or higher three times weekly of IFN; 2) treatment for at least 6 mo; 3) treatment completion; 4) lower baseline HCV RNA; 5) female gender; and 6) early virological negativity. Although limited by missing data, these relationships persisted in multivariate regression.Conclusions: SVR is more likely with larger IFN dose, longer treatment duration, treatment completion, female gender, lower HCV RNA and early virological negativity. For appropriate treatment candidates, regimens should consist of three million units of IFN three times weekly for at least 6 mo, with patients encouraged to complete the full course.

Management of hepatitis C virus infection in hemodialysis patients

“…HCV RNA level, HCV genotype, ALT pattern, female gender, duration of infection, liver fibrosis stage, and treatment duration were not associated with SVR [8] . These conclusions are conflicting with that of Gordon et al [9] . Accordingly, the factors associated with the SVR are worthy of further investigations.…”

“…Multiple factors are associated with the high risk of HCV transmission in MHD patients [3] . Standard interferon alpha (ST-IFNα) and pegylated IFNα (PEG-IFNα) are currently the main treatment strategies for HCV infection in MHD patients, and the key problems are how to increase the sustained virological response (SVR), control the side effects and minimize the dropout rates [1,2,[8][9][10] . This review summarizes the advancement in understanding the prevalence, risk factors, monitoring strategy, and more importantly, prophylaxis and treatment of HCV infection in MHD patients.…”

“…The rationale for this recommendation is that ST-IFNα has appeared as effective as PEG-IFNα in MHD persons because its excretion is reduced in these patients, its adverse effects may be lower, and management of adverse effects is relatively easier than PEG-IFNα [1] . Because ribavirin has the high risk of inducing or aggravating hemolytic anemia in uremic patients and can not be removed by hemodialysis, it should be prohibited or used at a markedly reduced daily dose with careful monitoring of anemia and other adverse effects in MHD patients [1,[8][9][10] . If RBV is to be applied, it should be given at an individualized dosing of 200 mg once a day, or 200 mg every other day, or 200 mg thrice weekly after hemodialysis, and substantial hematopoietic support is essential [57] .…”

“…If RBV is to be applied, it should be given at an individualized dosing of 200 mg once a day, or 200 mg every other day, or 200 mg thrice weekly after hemodialysis, and substantial hematopoietic support is essential [57] . In a meta-analysis made by Gordon et al [9] in 2009, which included 428 patients from 20 prospective studies from 1966 to February 2009, IFNα treatment for at least six months against chronic HCV infection in MHD patients was shown to result in a high overall SVR of 45%. Both univariate and multivariate regression analyses demonstrated that the higher SVR was related to the following factors: (1) three million units or higher dosage of IFNα, three times weekly; (2) completion of treatment for at least six months; (3) lower baseline HCV RNA; (4) female gender; and (5) early virological negativity [9] .…”

“…In a meta-analysis made by Gordon et al [9] in 2009, which included 428 patients from 20 prospective studies from 1966 to February 2009, IFNα treatment for at least six months against chronic HCV infection in MHD patients was shown to result in a high overall SVR of 45%. Both univariate and multivariate regression analyses demonstrated that the higher SVR was related to the following factors: (1) three million units or higher dosage of IFNα, three times weekly; (2) completion of treatment for at least six months; (3) lower baseline HCV RNA; (4) female gender; and (5) early virological negativity [9] . In a later meta-analysis by Alavian et al [8] published in 2010, 491 MHD patients from 21 studies of ST-IFNα and 279 MHD patients from 12 studies of PEG-IFNα were meta-analyzed.…”