[Natural history of hepatitis C virus infection in dialysis].

Dialysis patients remain at risk for acquiring hepatitis C virus (HCV) infection. The issue of the natural history of HCV infection among patients undergoing long-term dialysis is surrounded by great controversy. An accurate assessment of the clinical outcomes of HCV in end-stage renal disease (ESRD) is hampered by numerous items, namely the primary features of the disease: its onset is rarely recognized and its course is prolonged exceedingly. Viral, host, and/or environmental factors may influence the outcome of chronic HCV infection but their precise role in promoting disease progression are yet to be defined in dialysis patients. It is well known that HCV-related liver disease usually runs an asymptomatic course and the liver-related mortality in the dialysis population is very low. In addition, it has been suggested that the HD procedure may exert a protective effect on the course of HCV and several mechanisms have been advocated to this purpose. However, the rate of persistence of HCV after acute hepatitis C is probably extremely high among dialysis patients. Recently a strong and independent relationship between HCV status and survival in the dialysis population has been observed. The frequency of liver cancer in dialysis patients appears higher than that seen in the general population. These findings have been obtained by several prospective studies with adequate size and long follow-ups. The natural history of HCV in patients on long-term dialysis will be better defined as more data are generated from ongoing studies. Dialysis patients desperately need effective and safe antiviral agents for the treatment of HCV-related liver disease.