Role of granulocyte colony-stimulating factor [G-CSF]/Filgrastim as an adjunct in chronic hepatitis C management

Drug-induced hematotoxicity is the commonest reason for reducing the dose or withdrawing interferon [IFN] therapy in a case of chronic hepatitis C thus depriving the patient of a possible cure. Traditionally, severe neutropenia has been considered an absolute contraindication to start antiviral therapy. Since the advent of adjunct therapy with Granulocyte-colony stimulating factor, the same is not true any more. Some recent landmark studies have used this adjunct therapy to help avoid antiviral dose reductions. although, addition of this adjunct therapy has been shown to significantly increase the overall cost of the treatment, if the infection is cured at the end of the day, this extra cost is worth bearing. Although, more studies are needed to refine the true indications of this adjunct therapy, determine the best dose regimen, quantify the average extra cost and validate that whether or not the addition of this therapy increases the sustained virologic response rates achieved, the initial reports are encouraging. Therefore, although not recommended on routine basis, some selected patients may be given the benefits of these factors. In this article, a review of the current literature on this subject is given followed by few suggested recommendations at the end to help develop local guidelines

Chronic hepatitis C with associated renal disease: Suggested recommendations for the development of local guidelines

HCV infection is estimated to be the commonest liver disease in renal dialysis patients with a prevalence rate of 5% to as high as 50% in some centres. Although no local Pakistani data exists, any estimation of <50% would probably be an underestimation. Since, end-stage-kidney disease is generally an immunocompromised state, antibodies to hepatitis C virus [HCV] may not develop despite of the presence of active hepatitis C infection. The diagnosis of HCV infection thus requires reverse-transcriptase polymerase chain reaction [RT-PCR]. As far as treatment is concerned, ribavirin has traditionally been considered contraindicated in advanced kidney disease patients because it causes hemolytic anemia in a significant number of patients. Also, pegylated interferon, which is the current standard in the management of chronic hepatitis C cases, is generally not advised in renal disease patients owing to its prolonged half life and thus increased probability of side effects. It is thus clear that chronic hepatitis C infection in association with renal disease poses a special diagnostic and managerial problem. In the recent past, many landmark studies have greatly increased our insights in the diagnosis and management of hepatitis C cases and many conditions previously considered to be contraindications for antiviral therapy are no more considered contraindicated. The current evidence is enough to warrant a thorough revision on this subject. In this article, the current state-of-the-art standards on this subject are given followed by a few suggested recommendations at the end