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