REPLY
Eradication of Hepatitis C Virus after Interferon-
Therapy
Raffaella Romeo;
Stanislas Pol; and
Christian Brechot
15 March 1995 | Volume 122 Issue 6 | Pages 474-475
IN RESPONSE:
We agree with Dr. Agnello that a few copies of HCV RNA may exist after interferon treatment even if PCR results are negative. Nevertheless, the inability to detect HCV RNA in the serum, liver, and peripheral blood mononuclear cells is a strong argument for eradication, given the long-term follow-up of these patients who continue to have normal liver function and normal liver histologic results. A longer follow-up of these patients should confirm our hypothesis of the absence of substantial HCV infection.
In regard to the letter by Dr. Akpolat and colleagues, we never stated that hemodialysis was a contraindication to interferon-
therapy. On the contrary, our center has initiated such studies (see Ref. 1 in next article). The potential interest of this approach is reinforced by the low viremia that is observed in patients who receive hemodialysis (see Ref. 2 in next article) and is an independent positive predictive factor of the response to interferon (see Ref. 3 in next article). In addition, the need for treating patients on hemodialysis is underlined by the frequent histopathologic deterioration observed in 70% of persons receiving kidney transplants who have HCV infection[4].
Interferon- therapy for patients who have hemodialysis does, however, imply that patients should be carefully monitored for potential side effects (see Ref. 1 in next article). In addition, biological variables (such as alanine aminotransferase levels) and virologic variables (such as serum HCV-RNA) can be difficult to evaluate in these patients because of the presence of renal disease, concomitant treatment with other drugs, and immunodepression. The potential pitfalls clearly indicate the need for careful evaluation and monitoring in these patients.
1. Pol S, Thiers V, Carnot F, et al. Efficiency of -2b interferon in the treatment of HCV infection in hemodyalized patients (Abstract). Hepatology. 1994; 20:253.
2. Lindsay KL, El-Shahawy M, Milstein S, et al. HCV RNA levels are lowered during hemodialysis in patients with chronic hepatitis C (Abstract). Hepatology. 1994; 20:570.
3. Nousbaum JB, Pol S, Nalpas B, Landais P, Berthelot P, Brechot C, et al. Hepatitis C virus type II (1b) in Europe. Decreasing prevalence over the last decade; its association with cirrhosis, hepatocellular carcinoma and low response to interferon . Ann Intern Med. 1995; 122:161-8.
4. Pol S, Debure A, Degott C, et al. Chronic hepatitis in kidney allograft recipients. Lancet. 1990; 335:878-80.
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