Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.548
Peer-review started: September 20, 2014
First decision: November 19, 2014
Revised: December 10, 2014
Accepted: December 29, 2014
Article in press: December 29, 2014
Published online: March 27, 2015
Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the “silent” clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the “beneficial” impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of “hepatoprotective” cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking.
Core tip: Despite reduction of hepatitis C prevalence, hemodialysis (HD) patients still comprise a high risk group. HD individuals with chronic hepatitis C virus infection have lower aminotransferase and viral levels, milder histological features and a lower frequency of cirrhosis and hepatocellular carcinoma. However, liver disease is related to higher cardiovascular and all-cause mortality in this patient population. According to current recommendations, choice of treatment is interferon or pegylated interferon, whilst low doses of ribavirin also seem to have promising results. Data regarding new protease inhibitors are still lacking.