Long-Term Viral Negativity After Interferon for Chronic Hepatitis C Virus Infection in Hemodialysis

Abstract

SummaryBackground and objectives Interferon (IFN) and pegylated-IFN treatment of hepatitis C virus (HCV) infection in hemodialysis patients result in sustained virological response (SVR) rates of 45% and 37%, respectively. Although most nonhemodialysis patients who achieve SVR remain persistently viral negative, the durability of SVR in hemodialysis patients is unknown. We analyzed the rate of long-term virological negativity in hemodialysis patients who achieved SVR after IFN or pegylated-IFN through analysis of patientlevel data.Design, setting, participants, & measurements After performing a systematic literature review for IFN-based treatment of hemodialysis patients with chronic HCV infection, we extracted patient-level data on patients who achieved SVR. We performed life table analysis to estimate long-term virological negativity rates after SVR in patients who continued on hemodialysis or subsequently underwent kidney transplantation.Results Long-term HCV RNA outcomes following SVR were available for 121 hemodialysis patients (20 studies) and 45 patients who subsequently underwent transplantation (11 studies). The probability of remaining HCV RNA negative was 86% (95% confidence interval, 77% to 96%) for patients followed on hemodialysis 48 months after SVR and 95% (95% confidence interval, 89% to 100%) for kidney recipients followed 48 months after transplant.Conclusions Viral negativity from IFN-based HCV treatment in hemodialysis patient appears durable during extended follow-up, including after kidney transplantation. The certainty of the viral negativity estimate is limited by the small number with follow-up beyond 48 months or longer. Transplantation does not confer an increased risk of relapse. Future research should investigate whether IFN-based treatment improves clinical outcomes for hemodialysis patients.

Hepatitis C and its impact on renal transplantation

“…The likelihood of remaining HCV RNAnegative for 48 months following antiviral treatment has been reported to be 86% for patients on haemodialysis and 95% after transplantation. 38,39 A minority of patients with HCV infection who are on dialysis receive antiviral treatment. Data from the Dialysis Outcomes and Practice Patterns Study showed that only ~1.0% of 4,589 patients with HCV infection received antiviral medication.…”

Peginterferon alfa-2a with or without low-dose ribavirin for treatment-naive patients with hepatitis C virus genotype 2 receiving haemodialysis: a randomised trial

“…Although haemodialysis patients with HCV infection who receive renal transplantation have survival advantages over those who remain on maintenance dialysis, these patients still have poor patient and graft survival, as well as have poor responses to interferon (IFN)-based therapy 7–9. In contrast, haemodialysis patients who eradicate HCV infection have improved clinical outcomes, whether they remain on maintenance dialysis or have had renal transplantation 10 11…”

Timing of hepatitis C virus infection treatment in kidney transplant candidates

“…Several of these specific scenarios are reviewed below and in Table . Importantly, these recommendations can be made because clearance of HCV in treated patients on the waitlist is durable after transplantation …”