[Natural history, diagnosis and treatment of chronic hepatitis B and C in hemodialysis patients]

Translated title of the contribution: [Autom. eng. transl.] [Natural history, diagnosis and treatment of chronic hepatitis B and C in hemodialysis patients]

Research output: Contribution to journalArticle

Abstract

Chronic hepatitis B and C are important causes of liver disease in hemodialysis units. The most important route of transmission is the inapparent parenteral route; known risk factors are the high prevalence of HBV and HCV infections in hemodialysis units, previous blood transfusions, long-term dialysis treatment, frequent changes of hemodialysis unit, and previous renal transplants. The source, time and duration of infection are often difficult to ascertain. The studies investigating the natural history of viral hepatitis in hemodialysis patients are few and limited by a short follow-up, but they show an independent and negative impact on survival due to an increased risk of liver cirrhosis and hepatocellular carcinoma. The treatment options include conventional or pegylated interferon (alone or in association with ribavirin) and the nucleoside/nucleotide analogs. The aim of treatment is viral eradication or persistent suppression of viral replication. The altered pharmacokinetics, the increased risk of drug-related toxicity, and the need for renal transplant complicate the management of antiviral therapy. In patients with chronic HBV infection and active replication the most common approach is persistent suppression of viral replication using nucleoside/nucleotide analogs. As regards hepatitis C, several clinical trials evaluating conventional interferon monotherapy have shown higher sustained virological response and dropout rates in dialysis patients than in patients with normal kidney function. Data about pegylated interferon as monotherapy or in association with ribavirin are promising but limited. Hemodialyzed patients obtaining a sustained virological response often maintain the response after kidney transplantation.
Translated title of the contribution[Autom. eng. transl.] [Natural history, diagnosis and treatment of chronic hepatitis B and C in hemodialysis patients]
Original languageItalian
Pages (from-to)262-273
Number of pages12
JournalGIORNALE ITALIANO DI NEFROLOGIA
Volume27
Publication statusPublished - 2010

Keywords

  • Antiviral Agents
  • Drug Therapy, Combination
  • Hepatitis B, Chronic
  • Hepatitis C, Chronic
  • Humans
  • Interferon-alpha
  • Renal Dialysis

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