Should ribavirin be used to treat hepatitis C in dialysis patients?

Abstract

Hepatitis C virus infection adversely affects outcomes in patients with chronic kidney disease undergoing maintenance dialysis. Pegylated interferon and ribavirin, the standard-of-care treatment in patients with intact renal function, is associated with severe side effects, toxicity, and high dropout rates in this population. Ribavirin has an important role in maintaining antiviral response following completion of therapy and increases sustained viral response (SVR) rates. However, the use of ribavirin in dialysis patients has been limited by the high frequency of severe hemolytic anemia and is currently reserved for study protocols and highly selected candidates treated at experienced centers. Encouraging data from small trials have shown a significant increase in SVR rates with the use of different dosing regimens of ribavirin in addition to interferon-based therapy and aggressive erythroid-stimulating agent support in dialysis patients. Use of ribavirin in selected dialysis patients, particularly renal transplant candidates, by experienced clinicians is appropriate.

• Authors: Andres F Carrion, Fabrizio Fabrizi, Paul Martin
• Journal: Seminars in dialysis (Semin Dial) 2011 May-Jun Vol. 24 Issue 3 Pg. 272-4 ISSN: 1525-139X [Electronic] United States
• PMID: 21480995 (Publication Type: Editorial)
• Copyright: © 2011 Wiley Periodicals, Inc.

Chemical References

• Antiviral Agents
• Interferon alpha-2
• Interferon-alpha
• Recombinant Proteins
• Erythropoietin
• Polyethylene Glycols
• Ribavirin
• peginterferon alfa-2b
• peginterferon alfa-2a

Topics

• Anemia, Hemolytic (chemically induced, prevention & control)
• Antiviral Agents (administration & dosage, adverse effects, pharmacokinetics)
• Erythropoietin (therapeutic use)
• Hepatitis C, Chronic (drug therapy)
• Humans
• Interferon alpha-2
• Interferon-alpha (therapeutic use)
• Polyethylene Glycols (therapeutic use)
• Recombinant Proteins
• Renal Dialysis
• Ribavirin (administration & dosage, adverse effects, pharmacokinetics)