Treatment of hepatitis C virus infection and renal disease
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"documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2006;5 Supl 1:S49-52" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 196 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 152 "PDF" => 38 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Treatment of HBV–HCV coinfection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S49" "paginaFinal" => "S52" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Torres Ibarra" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Rocío" "apellidos" => "Torres Ibarra" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119319726?idApp=UINPBA00004N" "url" => "/16652681/00000005000000S1/v1_201906280857/S1665268119319726/v1_201906280857/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Treatment of hepatitis C virus infection and renal disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "S53" "paginaFinal" => "S55" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nahum Méndez-Sánchez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Nahum" "apellidos" => "Méndez-Sánchez" "email" => array:1 [ 0 => "nmendez@medicasur.org.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Departamentos de Investigación Biomédica, Gastroenterologia & Unidad de Hígado. Fundación Clinica Médica Sur, México, D.F. México" "etiqueta" => "1" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Address for correspondence:" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Renal diseases occur frequently in patients chronically infected by hepatitis C virus (HCV). These may be causes or consequences of HCV infection. The prevalence of HCV infection in patients receiving hemodialysis is 6.7% to 10.2% in some centers in Mexico.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, the problem may be greater than these percentages suggest because the prevalence of HCV infection is as high as 50% in some countries.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> HCV infection frequently results in kidney damage. Membranoproliferative glomerulonephritis with or without cryoglobulinemia is the most significant renal disease associated with hepatitis C, followed by membranous nephropathy and hepatorenal syndrome.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Treatment of renal disease patients for HCV infection improves several parameters of renal function, particularly in patients with membranoproliferative glomerulonephritis and cryoglobulinemia.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">The mortality rate of HCV patients with liver cirrhosis is high.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> HCV infection is considered a risk factor independent from the death (RR = 1.57; 95% CI = 1.2-2).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These results are almost identical to those of a recent meta-analysis of 2,341 patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Because morbidity and liver transplant rejection rates are high in patients with renal disease,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> it is important to treat HCV infection prior to transplantation.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Patients receiving dialysis</span><p id="p0015" class="elsevierStylePara elsevierViewall">Interferon monotherapy is commonly used to treat HCV infections in patients receiving dialysis. However, most of the data in support of interferon monotherapy have been derived from small clinical trials whose outcomes are inconsistent. Recently, two meta-analyses provided evidence for the efficacy and safety of subcutaneous administration of 3 million units of interferon three times per week for 24 weeks to patients receiving dialysis. Fabrizi et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> reported that the sustained viral response (SVR) to interferon treatment of patients receiving dialysis is 37% (CI 95% 28–48, p < 0.0006), which is much greater than that of patients with normal renal function (17%-22%), particularly when high doses of interferon are used.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Because patients with renal failure are infected with genotype 1 HCV, the success of treatment is low (SVR = 30.6%, 95% CI = 20.9–48). Similarly, Russo et al.(14) reported an SVR of 33% (95% CI = 21–51). Mild to high doses of interferon (6 million units intramuscularly three times per week for 24 weeks) may increase the response rate to 53%, but there are no data to justify this practice. In the study of Fabrizi,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> genotype affected the response to treatment (SVRs of 26 and 31 for genotype 1 and genotypes other than 1, respectively).</p><p id="p0020" class="elsevierStylePara elsevierViewall">These two meta-analyses also showed that the discontinuation rate for patients receiving dialysis is 17%-29.6%, which is higher than the rate for nonuremic patients.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The main side effects are flu-like symptoms, leucopenia, depression, neurological disorders (confusion and seizure), and gastrointestinal disorders. Because of the cost of interferon and its side effects, it is not advisable to use it for patients with low life expectancies or those with comorbidities such as diabetes mellitus, congestive heart failure or malnutrition.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">In the past decade, combined therapy with interferon and ribavirin has improved virological and biochemical response rates.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Because the conventional dose of ribavirin causes hemolytic anemia in patients with renal failure, a reduced dose of ribavirin (200 mg three times per week) and a high dose of erythropoietin (20,000–30,000 IU/ week) are recommended. Combined therapy increases the HCV SVR of dialysis patients to 55%-65%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">The addition of a polyethylene glycol moiety to interferon facilitates slow release of interferon. The mean halflife of pegylated interferon in HCV patients with renal failure (58 h) is similar to that of patients without renal failure (52 h).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Therefore, the standard dose of pegylated interferon is considered safe for HCV patients receiving hemodialysis (180 μg/week for 48 weeks). There are few clinical studies on the use of pegylated interferon for HCV patients receiving dialysis. One study claimed that it results in a significant increase in SVR of dialysis patients with HCV,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> but this finding was refuted by another report.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Similarly, one report stated that liver transplant patients with relapsed HCV infection are intolerant of treatment with pegylated interferon,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and another reported that the pegylated interferon is well tolerated by transplant patients and that SVR rate is improved without serious side effects.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Renal transplant patients</span><p id="p0035" class="elsevierStylePara elsevierViewall">The treatment of chronic HCV patients who are prospects for renal transplantation deserves special attention because of the high morbidity and mortality associated with renal transplantation. Furthermore, the progression of hepatitis C is accelerated by transplantation.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> A small follow-up study of 29 patients showed that patients with renal failure and HCV infection who have no contraindications benefit significantly from interferon treatment, particularly in respect of survival and rejection rates.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Therefore, efforts should be made to optimize treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients with cryoglobulinemia</span><p id="p0040" class="elsevierStylePara elsevierViewall">The treatment of cryoglobulinemia is a controversial topic as some studies have demonstrated that it is improved by treatment of liver disease.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> However, the evidence in support of treatment of these patients was derived from small clinical studies. Recently, a cohort study of 25 patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> showed that treatment with interferon and ribavirin or pegylated interferon increased the SVR, reduced the degree of cryoglobulinemia, and improved proteinuria.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="p0045" class="elsevierStylePara elsevierViewall">Treatment of chronic HCV infection in subjects with renal failure requires further study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Recommendations of the consensus panel</span><p id="p0050" class="elsevierStylePara elsevierViewall">Should patients with renal disease and HCV infection be treated?</p><p id="p0055" class="elsevierStylePara elsevierViewall">The panel of consensus unanimously recommends antiviral treatment of these patients. Consequently, all patients should be evaluated to determine their eligibility for treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Evidence quality: 2</span><p id="p0060" class="elsevierStylePara elsevierViewall">What is the treatment of choice for patients with renal disease?</p><p id="p0065" class="elsevierStylePara elsevierViewall">Most of the panel members (58%) considered pegylated interferon monotherapy to be the treatment of choice. One-third (33%) considered standard interferon monotherapy to be the treatment of choice.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Evidence quality: 2</span><p id="p0070" class="elsevierStylePara elsevierViewall">Is the simultaneous use of erythropoietin and HCV medication recommended?</p><p id="p0075" class="elsevierStylePara elsevierViewall">Most members of the panel considered the use of erythropoietin to be justified but 47% of the panelists were in favor of only using it when antiviral treatment is combined with ribavirin.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Evidence quality: 2</span><p id="p0080" class="elsevierStylePara elsevierViewall">How should renal disease patients with HCV-HIV or HCV-HBV coinfection be treated?</p><p id="p0085" class="elsevierStylePara elsevierViewall">There is insufficient evidence to make recommendations on first line therapy for this complex group of patients.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Evidence quality: 3</span><p id="p0090" class="elsevierStylePara elsevierViewall">Should liver biopsies be performed on hemodialysis patients with chronic liver failure and HCV infection?</p><p id="p0095" class="elsevierStylePara elsevierViewall">The consensus panel recommended performing liver biopsies on renal failure patients who are receiving hemodialysis, are prospects for renal transplantation, and have no evidence of liver cirrhosis.</p></span><p id="p0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Evidence quality: 3</span></p></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Patients receiving dialysis" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Renal transplant patients" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients with cryoglobulinemia" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Recommendations of the consensus panel" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Evidence quality: 2" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Evidence quality: 2" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Evidence quality: 2" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Evidence quality: 3" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
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| 2024 November | 5 | 1 | 6 |
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| 2023 August | 9 | 2 | 11 |
| 2023 July | 4 | 1 | 5 |
| 2023 June | 3 | 6 | 9 |
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| 2020 October | 5 | 5 | 10 |
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| 2020 July | 1 | 1 | 2 |
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| 2020 April | 1 | 1 | 2 |
| 2020 March | 3 | 1 | 4 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 2 | 5 | 7 |
| 2019 December | 4 | 3 | 7 |
| 2019 November | 1 | 0 | 1 |
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