Treatment of hepatitis C virus infection in dialysis patients.

Hepatitis C virus (HCV ) infection is frequent in to be the same as that in patients not on dialysis who patients with end-stage renal failure treated by chronic have become infected as a result of transfusion: mild dialysis (and in allograft recipients), with a prevalence chronic hepatitis is observed for most patients, with a varying from 10% to 65% according to the geographical low HCV viraemia and a low HCV-related mortality area. The prevalence is significantly associated with but cirrhosis is observed in 10% of patients. It is the duration of dialysis and the number of transfused 1.4% (5), with evidence of nosocomial transmission (6,7); the incidence of seroconversion from negative to (11). The outcome of HCV-infected dialysis patients positive fell to 0.56% and then to 0% when universal awaiting renal transplantation is significantly worse precautions were reinforced, although the average than that of patients who had undergone renal trans- number of transfusions and proportion of patients plantation (12). with dialyser reuse or with monitors disinfected after In kidney allograft recipients, initial results from the each session did not change (8). USA and Europe (13,14) suggested similar graft and Epidemiological, serological and virological data on patient survivals in patients with and without anti- HCV infection in haemodialysis patients have been widely HCV antibodies, but more recent studies seem to reported throughout the world but the clinical impact, contradict these findings (15-18). These studies suggest i.e. survival, and the histopathological impact have not that antiviral therapies should be given to candidates yet been evaluated. While in the general population for renal transplantation, because immunosuppressive ~80% of HCV-infected patients have either fluctuating regimens for the prevention of allograft rejection result or constantly high aminotransferase values, biochemical in increased HCV replication ( leading to pathological abnormalities are usually less frequent in patients with deterioration in 75% of patients and a 25% incidence renal disorders (a third of dialysis patients and half of of cirrhosis, within 5 years after transplantation) (19). kidney recipients) (9). Thus, in the management of Renal transplantation precludes, to date, further anti- patients with end-stage renal disease and HCV infection, viral therapies because such therapies are associated clinical and biological data, specifically transaminase with a very low rate of virological efficacy (~6%) and levels, appear to be of little diagnostic value. As in the an unacceptably high rate of graft rejection (~45%) general population, liver biopsy is required for precise (20,21). evaluation of the grade and stage of liver disease, particu- HCV infection is clearly associated with glomerular larly for identifying cirrhosis. Given the risk of developing disease: clinical manifestations are mixed cryoglobuli- hepatocellular carcinoma, ultrasonography and a-feto- naemia, membranoproliferative or membranous neph- protein levels are warranted every 4 months in dialysis ritis. These extrahepatic complications may lead to patients with cirrhosis, as in all patients with cirrhosis (10). renal failure in native (22) as well as in transplanted kidneys (23), resulting in so-called de novo glomerulo- Why treat HCV infection in dialysis patients? nephritis, which may lead to non-functioning renal