Superiority of peginterferon α-2a and ribavirin combination over peginterferon α-2a monotherapy in the management of hemodialysis patients with chronic Hepatitis C virus infection.

Hepatitis C virus (HCV) is a common infection affecting 15% of hemodialysis population in Saudi Arabia resulting in delay in transplantation and long-term complications. The use of peginterferon resulted in sustained virologic response (SVR) in 40%-85% of patients, especially if combined with ribavirin. The treatment is hampered by the high dropout due to anemia and requirement of blood transfusion resulting from this therapy. Some studies have shown that the addition of increasing dose of erythropoiesis-stimulating agents (ESA) and reduced dose of ribavirin results in reduced dropout rate with high SVR. We conducted an open-label prospective study using either peginterferon α-2a alone (Group I, 32 patients) or peginterferon α-2a plus adjusted dose ribavirin (Group II, 26 patients). A total of seven patients dropped from the study (2 in Group I and 5 in Group II). Analysis was done only on patients who completed the study (thirty patients in Group I and 21 in Group II). There was no significant difference in the demographic data, HCV genotype, liver biopsy grade and stage, and laboratory tests between the two groups. Patients received ESA to combat expected anemia. Group II had a better early virologic response than Group I [17 out of 21 (80%) and 14 out of 30 (47%) respectively, P = 0.014] and better SVR [18 out of 21 (85%) and 15 out of 30 (50%) respectively, P = 0.009]. There were no differences in mean white blood cells, hemoglobin, and platelets between the two groups at any time with only four patients dropping out due to anemia or side effect of medications. Alanine aminotransferase was lower in both treatment groups compared to baseline with no difference between the groups. Peginterferon α-2a and ribavirin are superior to peginterferon α-2a alone in treating hemodialysis patients with chronic HCV infection.