EFFICACY AND TOLERANCE OF ALPHA-2B INTERFERON THERAPY ON HCV INFECTION OF HEMODIALYZED PATIENTS

A high frequency (25%) of anti-hepatitis C virus (HCV) antibodies is observed in French hemodialyzed patients; this is associated with detectable viremia in 85% and results in chronic hepatitis in more than 90%. We conducted a pilot study to examine the tolerance and efficacy of alpha-2b Interferon therapy upon HCV infection in hemodialyzed patients. Nineteen anti-HCV positive hemodialyzed patients were given a standard alpha-2b interferon regimen (3 megaunits subcutaneously three times weekly, following each hemodialysis) over six months as a treatment of biopsy-proven chronic hepatitis (N = 16) or acute hepatitis (N = 3). Thirteen of these 19 had increased levels of aminotransferase at the lime of treatment. Serum HCV RNA was tested qualitatively and quantitatively by the polymerase chain reaction and the bDNA test, respectively, at the beginning and at the end of antiviral treatment, and a third time at least six months after the end of therapy (mean follow up 18 +/- 9 months). HCV genotype was determined in the 15 patients who had detectable HCV RNA before treatment. The biological response (longterm response, relapse or non-response) was defined as usual according to the serum aminotransferase levels during therapy and at least six months after. A post-treatment liver biopsy, allowing comparison with semiquantitative pathological scores, was performed in 14 patients. Only one of the 19 treated patients did not complete therapy because of poor tolerance, while 18 of the 19 fairly tolerated a complete six month course of alpha-2b interferon. Among the 13 patients who had increased activities of aminotransferase prior to therapy, a long-term response, a relapse or a nonresponse was observed in 8, 3 and 2 patients, respectively. Genotype 1b was the most prevalent (8 of 15). Although HCV RNA was still detectable in only 46.7% by PCR and 36.4% by bDNA at the end of antiviral therapy, despite biological and histopathological improvement in most, in all but three patients serum HCV RNA reappeared during follow-up. Biological and histopathological improvement was also noted in those patients who had hepatitis despite undetectable HCV RNA before antiviral treatment. alpha-2b Interferon therapy of HCV hepatitis in hemodialyzed patients is well tolerated and is as efficient as in the general population. The frequency of virological relapse after discontinuation suggests that reinforced therapeutic schedules should be proposed to hemodialyzed patients. Discrepancies between biological, virological and histopathological results underline the need of an exhaustive post-treatment evaluation, including liver biopsy.