Khaja Quadri

Interferon-α in chronic hepatitis C infection in dialysis patients

Abstract This study assesses the efficacy and adverse effects of interferon-α (IFN-α) administered at a dosage of 3 million units three times weekly for 1 year in 17 hemodialysis patients with hepatitic C virus (HCV)-associated chronic hepatitis (biopsy proven). The patients were prospectively followed up for a period of 18 months. Liver biopsy was repeated after 6 months of treatment in 13 patients. Patients were classified according to the histological activity index. Biochemical and virological responses were evaluated at the end (end-of-treatment response) and 6 months after completion of therapy (sustained response). HCV RNA became negative in 76% of the patients after 12 weeks of treatment, in 88% after 12 months of treatment, and in 71% of the patients 6 months after completion of therapy. HCV genotype 4 was found in 60% of our population. Alanine aminotransferase (ALT) levels were initially increased in only 6 patients and normalized in 4 of these patients after 12 weeks of therapy, with end-of-treatment and sustained biochemical responses of 83% and 67%, respectively. Of 13 patients who underwent liver biopsies after 6 months of therapy, 11 patients (85%) showed histological improvement. One patient could not tolerate therapy because of marked lethargy and myalgia; the other patients had minor side effects that did not require discontinuation of treatment. Two patients received a cadaveric renal transplant after 1 year of IFN treatment, and they continued to maintain biochemical and virological responses after a follow-up of 17 and 28 months, respectively.

Effect of intravenous alfacalcidol on lymphocyte phenotyping in hemodialysis patients

Chronic renal failure is associated with decreased production of active vitamin D and also results in altered lymphocyte population. We studied the effect of alfacalcidol on lymphocyte phenotype. There were 15 patients (10 males, 5 females) with a mean age of 54.3+/-14.4 years who had been on chronic maintenance haemodialysis for a mean period of 3.2+/-1.5 years. Intravenous alfacalcidol was given three times weekly during dialysis for a duration of 6 months. Our results show a significant increase in NK cells from 0.20+/-0.12 to 0.27+/-0.28 (P=0.001), without a significant change in CD2, CD19, CD4, CD8 population, and CD4/CD8 ratio.

ANTI-HCV POSITIVE HEMODIALYSIS PATIENTS: CLINICAL, BIOCHEMICAL, HISTOLOGIC AND VIROLOGIC STUDY AND A PROPOSED MANAGEMENT SCHEME

The significance of suchfindings is not totally understood; this may reflect eitherpast, resolved infection, or active infection with viralreplication and chronic hepatitis. There is incomplete dataon the clinical, biochemical, histological and virologicfeatures of these patients. In addition, there are no reportsthat address all these issues simultaneously in the samegroup of patients. The significance of anti-HCV positivityin hemodialysis units is important for the followingreasons: 1) these patients are potentially kidney transplantcandidates; 2) many of these patients exhibit no clinical orbiochemical abnormalities of the liver;