Background In end-stage renal disease (ESRD) patients, hepatitis C virus (HCV) eradication improves patient and graft survival.
Aim To determine optimal use of erythropoietin (EPO) and ribavirin, to compare ribavirin concentrations with those of HCV patients having normal renal function and to evaluate sustained virological response (SVR) in a prospective observatory of ESRD candidates for renal transplantation.
Methods Thirty-two naïve patients were treated with Peg-IFN-α2a and ribavirin. Two different schedules of ribavirin and EPO administration were used: starting ribavirin at 600 mg per week and adapting EPO when haemoglobin (Hb) fell below 10 g/dL (adaptive strategy) or starting ribavirin at 1000 mg per week while increasing EPO from the start of treatment (preventive strategy).
Results Patients treated with the adaptive strategy had lower median Hb levels (9.6 vs. 10.9 g/dL, P = 0.02) and more frequent median Hb levels below 10 g/dL (58 vs. 5%, P = 0.0007) despite lower median ribavirin doses (105 vs. 142 mg/day, P < 0.0001) than patients treated with the preventive strategy. There was a trend for more frequent transfusion in patients treated with the adaptive strategy than in patients treated with preventive strategy (50 vs. 20%, P = 0.08). Compared to patients with normal renal function, ESRD patients had lower ribavirin concentrations during the first month (0.81 vs. 1.7 mg/L, P = 0.007) and similar concentrations thereafter. SVR was reached in 50%.
Conclusions Pegylated interferon (Peg-IFN) and an adapted schedule of ribavirin are effective in ESRD patients. Increasing EPO from the start of treatment provides better haematological tolerance. The optimal dosage of ribavirin remains unresolved, in light of frequent side effects.