Revised: April 3, 2014
Accepted: April 16, 2014
Published online: June 27, 2014
The prevalence of hepatitis C virus (HCV) infection in patients on maintenance hemodialysis (MHD) is relatively higher than those without MHD. Chronic HCV infection detrimentally affects the life quality and expectancy, leads to renal transplant rejection, and increases the mortality of MHD patients. With the application of erythropoietin to improve uremic anemia and avoid blood transfusion, the new HCV infections during MHD in recent years are mainly caused by the lack of stringent universal precautions. Strict implementation of universal precautions for HCV transmission has led to markedly decreased HCV infections in many hemodialysis units, but physicians still should be alert for the anti-HCV negative HCV infection and occult HCV infection in MHD patients. Standard interferon alpha and pegylated interferon alpha monotherapies at a reduced dose are currently the main treatment strategies for MHD patients with active HCV replication, but how to increase the sustained virological response and decrease the side effects is the key problem. IFNα-free treatments with two or three direct-acting antivirals without ribavirin in MHD patients are waiting for future investigations.
Core tip: The new hepatitis C virus (HCV) infections during maintenance hemodialysis (MHD) in recent years are mainly caused by the lack of stringent universal precautions. Strict implementation of universal precautions for HCV transmission has led to markedly decreased HCV infections in many hemodialysis units, but the anti-HCV negative HCV infection and occult HCV infection in MHD patients still should be noted. How to increase the sustained virological response and decrease the side effects is the key problem for the currently recommended interferon alpha-based antiviral therapy in MHD patients. Interferon alpha-free treatments with two or three direct-acting antivirals without ribavirin in MHD patients are waiting for future investigations.