Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

Abstract

AIM: Hepatitis C virus (HCV) infection is very common among end-stage kidney disease patients on hemodialysis, but its natural history is not known. METHODS:In this study, 189 dialysis patients (case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparable periods. The longest follow-up was 23 years in dialysis cases. The disease activities were graded into "asymptomatic" if ALT was less than 40 (35 in cases) IU/L, "low activities" if ALT was 40 (35)-79 IU/L, and "high activities" if ALT was above 80 IU/L during the last or latest 4 year period. RESULTS:All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA. Of the 50 controls followed up for more than 15 years, 34 had high activities, and none cleared HCV RNA. There were 60 controls who were asymptomatic, but they were all positive for HCV RNA, while 22.3% of asymptomatic dialysis cases were RNA negative. No dialysis patients with chronic hepatitis C progressed to cirrhosis, whereas the disease progressed to cirrhosis in more than one quarter of the controls. These differences were highly significant (P<0.0001).

The epidemiology of hepatitis C infection in the United States

“…59 Others at risk for more rapid fi brosis progression include individuals coinfected with HIV, 60 individuals with hypogammaglobulinemia infected by HCVcontaminated IV immunoglobulin, 61 and liver transplant recipients. 62,63 Groups associated with mild/moderate HCV-induced liver fi brosis include children infected in utero by HCV-infected mothers and those infected in childhood, [64][65][66] hemophiliacs infected by contaminated blood clotting factors, 67 individuals undergoing hemo dialysis, 68 women infected at young ages with contaminated anti-D immune globulin, 69 and women aged 20 years or less when infected through blood transfusion and others similarly affected. 70,71 Evaluation of the immunologic characteristics of these patient groups and studies of the characteristics of the associated viral strains (e.g., quasispecies variability) may provide clues to the mechanisms of HCV-induced disease progression.…”

The treatment of chronic hepatitis C with peginterferon alfa-2a (40kDa) plus ribavirin in haemodialysed patients awaiting renal transplant

“…Although ribavirin may potentially be highly toxic in patients undergoing haemodialysis [1], and preliminary evidence suggests that hepatitis C is a mild and slowly progressing disease in this patient population [2], more consistent data indicate that not treating patients who are to undergo renal transplantation may lead to an increased risk of hepatitis C virus (HCV)-mediated allograft nephropathy [3,4], progression of liver disease [5], and diabetes [6]. For this 0168 The authors who have taken part in this study declared that they have no relationship with the manufacturers of the drugs involved either in the past or present and did not receive funding from the manufacturers to carry out their research.…”

Efficacy of Interferon-α in the Treatment of Chronic Hepatitis C in Dialysis Patients: Two Therapeutic Protocols Compared

“…The prevalence of HCV infection in these patients considerably exceeds the prevalence recorded in the general population, reaching up to 91% according to some reports [3, 4]. The natural course of the disease in this patient population is as a rule less severe than in patients with normal renal function, which is explained by the altered immune reaction in the presence of uremia and lower viremia that probably results from mechanical destruction of the virus on dialysis membrane [5,6,7]. Yet, a HCV infection during the course of HD should be properly treated because of generally higher mortality observed in these patients compared to HCV-negative dialysis patients and possible progression of untreated hepatic disease during the treatment with immunosuppressants following kidney transplantation [8,9,10,11].…”