Service de Gastroentérologie et Hépatologie, Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
J Clin Virol. 2013 Feb;56(2):146-9. doi: 10.1016/j.jcv.2012.10.009. Epub 2012 Nov 11.
Chronic hepatitis C virus (HCV) infection is the most common chronic liver disease in patients with end stage renal disease (ESRD) and is well known as a frequent cause of mortality and graft loss among haemodialysed and kidney transplant patients. Up to now, there are no data on antiviral efficacy and tolerability of available protease inhibitors (telaprevir and boceprevir) in HCV infected haemodialysed patients.
We report 4 cases of HCV infected haemodialysed patients, who have not responded to a prior course of pegylated interferon (Peg-IFN) and ribavirin (RBV) and who were listed for kidney transplantation (KTx). These 4 patients received a second-line antiviral treatment with Peg-IFN, RBV and telaprevir.
After 12 weeks of triple therapy, tolerability was acceptable and HCV-RNA became undetectable in 3/4 patients. Mild side-effects included anaemia leading to increasing the doses of erythropoietin (EPO). Dose of RBV ranged from 200mg three times a week to 200mg/day.
Triple therapy with a first generation protease inhibitor could be the new standard for the treatment of HCV patients with ESRD. This needs to be confirmed by larger series.
慢性丙型肝炎病毒（HCV）感染是终末期肾病（ESRD）患者中最常见的慢性肝脏疾病，是血液透析和肾移植患者死亡和移植物丢失的常见原因。到目前为止，尚无关于抗病毒药物在 HCV 感染血液透析患者中的疗效和耐受性的数据。
我们报告了 4 例 HCV 感染的血液透析患者，他们对先前的聚乙二醇干扰素（Peg-IFN）和利巴韦林（RBV）治疗无反应，并且已被列入肾移植（KTx）名单。这 4 例患者接受了 Peg-IFN、RBV 和 telaprevir 的二线抗病毒治疗。
在三联治疗 12 周后，耐受性可接受，3/4 例患者的 HCV-RNA 检测不到。轻度副作用包括导致红细胞生成素（EPO）剂量增加的贫血。RBV 的剂量范围为每周 3 次 200mg 至每天 200mg。
第一代蛋白酶抑制剂三联疗法可能成为治疗 ESRD 合并 HCV 患者的新标准。这需要更大系列的研究来证实。
