Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study

Abstract

There is no published study from India on hepatitis C virus (HCV) treatment in dialysis patients. Patients on dialysis with HCV infection treated with pegylated interferon (Peg-INF) monotherapy were studied. All patients were subjected to HCV-polymerase chain reaction, viral load, genotype, and liver biopsy. Quantitative HCV-RNA was performed monthly. Patients with genotype 1 and 4 were given 12 month therapy while those with genotypes 2 and 3 were given 6 months therapy. Response was classified as per standard criteria of rapid virological response (RVR), early virological response (EVR), end of treatment response (ETR), and sustained virological response (SVR). A total of 85 patients were treated. Mean age was 35.2 ± 10.5 (range 15–67) years, and 77.6% were males. HCV genotypes were 1 in 40.9%, 2 in 12%, 3 in 36.1%, 4 in 3.6%, and others in 7.2%. Mean viral load was 106 copies/mL. Mean liver biopsy grade was 4 ± 1.7 and stage 0.8 ± 0.8. Mean time from diagnosis of HCV infection and the treatment start was 10.7 ± 14.3 months. One patient died of unrelated illness, one was lost to follow-up, and three could not sustain treatment due to cost. Forty-three of the 80 (54%) patients had RVR while 49 (61%) patients had EVR and ETR. There was no difference in term of RVR related to genotype. Fifty -four percentage had SVR. Mild flu-like symptoms were seen in all patients. Sixty-four (80%) patients required increase in erythropoietin doses. Twenty-eight (35%) patients developed leukopenia (three treatment-limiting) and 16 (20%) developed thrombocytopenia (one treatment-limiting). Five patients developed tuberculosis, five bacterial pneumonia, and one bacterial knee monoarthritis. None of the patients developed depression. Our study concludes that Peg-INF monotherapy resulted in 54% RVR and SVR in dialysis patients with HCV infection. Therapy was well-tolerated with minimal side effects. There was no effect of viral genotype on response to therapy.

Hemodialysis Patients Treated for Hepatitis C Using a Sofosbuvir-based Regimen

“…Handling of HCV-infected patients was previously described in detail. 10 Patients with positive anti-HCV antibodies were further investigated for their qualitative HCV RNA, HCV viral load, and HCV genotype as described previously. 10 Because of our previous experience of only 1 patient with histological cirrhosis, 11 we clinically assessed the activity of liver disease, and no patient underwent liver biopsy.…”

“… 10 Patients with positive anti-HCV antibodies were further investigated for their qualitative HCV RNA, HCV viral load, and HCV genotype as described previously. 10 Because of our previous experience of only 1 patient with histological cirrhosis, 11 we clinically assessed the activity of liver disease, and no patient underwent liver biopsy. Before starting treatment, hemoglobin, total leukocyte count, differential leukocyte count, platelets, reticulocyte counts, and alpha fetoprotein were assessed in all patients using standard methods.…”

“…Diagnosis of HCV, polymerase chain reaction, and genotype testing were described previously. 10 Liver fibrosis was measured noninvasively by transient elastography (Fibroscan, Echosens, Paris, France), and the liver stiffness measurement was expressed in kilopascals. A cutoff value of <6 kPa for the liver stiffness measurement excluded fibrosis, and >9 kPa for the liver stiffness measurement was regarded as significant fibrosis.…”

“…9 We showed a 54% sustained virological response (SVR) in our patients while using pegylated IFN monotherapy with no impact of genotype on SVR, although treatment was limited by significant side effects in these patients. 10 With the development of direct antiviral agents (DAAs), therapy for HCV has been revolutionized. However, there are 2 issues related to DAAs.…”

Sofosbuvir Based Regimen in Management of Hepatitis C for Patients With End Stage Renal Disease on Hemodialysis: A Single Center Experience from India

“…Peginterferon based treatment is successful in achieving SVR in only about half of the patients receiving the treatment and is associated with significant side effects, which can prohibit the treatment completion. 4 Goel et al showed 58% response when ribavirin was used with peginterferon. 5 The major limitation of treating patients on dialysis with sofosbuvir based regimens is limited safety data.…”