In contrast, the side-effects of IFN treatment are very important for the patients with ESRD. In several situations, Belinostat clinical trial the IFN treatment could not be continued in those patients. Liver biopsy was avoided because of the risk of bleeding in these patients[21]. Recently, a pharmacokinetic study was carried out with PEG-IFN in subjects with various degrees of stable renal failure who were not yet dialysis dependent. Adsorption and distribution of PEG-IFN were similar in subjects with stable chronic renal impairment versus individuals with normal renal function[22]. The dose of 135 ��g of PEG-IFN in patients with ESRD gave similar serum concentrations to a dose of 180 ��g in patients with normal renal function. On the trials of PEG-IFN in patients with end-stage renal disease have been designed using weekly doses of 135 ��g (as opposed to 180 ��g)[7].
HCV genotype 1 is very common in Turkey. Similarly, all of the patients in the present study had genotype 1. Although the response to IFN treatment is not excellent in genotype 1, our results were outstanding[23]. Most of the patients in our study were infected with genotype 1b (86.4% group A, 92.9% group B). Recently, Kokoglu et al reported the results of a controlled study in which PEG-IFN 135 ��g/wk for 48 wk was used in hemodialysis patients with HCV infection. They found 83.4% virological EOR and 71.4% biochemical EOR[7]. Sporea et al reported on a 50% SVR in hemodialysis patients receiving PEG-IFN 180 ��g/wk[24]. In another study, virological response was 40% with PEG-IFN.
The difference in virological response could be related to the duration of treatment in the last study (24 wk) and the molecular weight of PEG-IFN (17 kDa)[25]. We found in our study 82.4% virological EOR and 71.4% biochemical EOR. PEG-IFNs are likely to become a valuable addition for HCV therapy in ESRD when combined with reduced ribavirin doses. However, the pharmacokinetics and tolerability of PEG-IFN and ribavirin combination therapy need to be studied in prospective studies[26]. To date, PEG-IFN and ribavirin combination therapy is the treatment of choice for patients with HCV infection. Ribavirin is metabolized by the kidneys and its clearance reduces in patients with ESRD. High ribavirin serum levels markedly increase the risk of hemolytic anemia and the use of ribavirin in uremic patients, who are often already anemic, could cause severe and life-threatening anemia.
Thus, a combination therapy with ribavirin is not an option for treatment of chronic HCV infection in hemodialysis patients[27]. We found in the present study 64.7% SVR and we can expect that in these subjects the use of PEG-IFN would lead to a higher rate of SVR than that observed with standard IFN, probably with a higher rate of adverse effects[11]. AV-951 PEG-IFN therapy had a successful efficacy in the present study but tolerability was not perfectly. We had to stop the treatment in five patients (22.