Abstract
Although a large number of drugs have been used to treat chronic hepatitis C (CHC), there still remains a great challenge to treat maintenance hemodialysis (MHD) patients with chronic hepatitis C. To clarify the immunnoloregulation of double filtration plasmapheresis (DFPP) in MHD patients with CHC, DFPP was performed in 20 MHD patients with CHC (HCV-antibody positive, serum HCV RNA >500 IU/ml more than 6 months and HCV genotype 1b). The clinical data was collected and peripheral blood mononuclear cells (PBMCs) were analyzed by flow cytometry at the time of hour 0, hour 3, day 3, day 7 and day 28 after the DFPP, respectively. Serum HCV particles could be removed partially by the DFPP. The titer of serum HCV RNA could remain in a lower level even 28 days after the treatment. Compared to MHD patients without HCV infection, the frequencies of innate immune cells were similar in MHD patients with CHC, while Th1/Th2 was elevated and the frequencies of regulatory T (Treg) cells were higher in those MHD patients with CHC. The frequencies of monocytes and natural killer (NK) cells remained after the DFPP in MHD patients with CHC. There were no significant changes of Th1, Th2 and Th1/Th2 in PBMC after DFPP. DFPP could reduce the frequencies of Th17 cells and Treg cells in PBMC from 7 days after DFPP in MHD patients with CHC. DFPP could partially remove the serum HCV particles mechanically. The titer of HCV RNA could remain in a lower level at least for 28 days probably due to the redistribution of the immunocytes in circulation.
Highlights
Chronic hepatitis C (CHC) is the main cause of chronic liver disease in maintenance hemodialysis (MHD) patients who are at particular high risk for hepatitis C virus (HCV) infection
It has been documented that CHC among MHD patients was mild in disease activity and was not so progressive compared to the controls with CHC[20], in MHD patients, HCV infection exhibited distinct clinical patterns, including associations with higher dialysis treatment vintage, and is associated with higher mortality[8]
Combination of RBV with PEG-IFN is considered the gold standard of therapy in HCV-positive patients with normal renal function [9]. This therapeutic schedule was recommended in MHD patients with HCV, the risk of severe life-threatening side effects in this population could not be ignored [12] [21]
Summary
Chronic hepatitis C (CHC) is the main cause of chronic liver disease in maintenance hemodialysis (MHD) patients who are at particular high risk for hepatitis C virus (HCV) infection. Among MHD patients, the prevalence of CHC varies greatly, from less than 5% to nearly 60% according to different areas of the world [1,2,3,4,5]. It was recommended to monitor the markers of HCV routinely in MHD patients [7]. What’s more, it has been reported that HCV was associated with higher all-cause and cardiovascular mortality in MHD patients [8]. Several studies have pointed that the effective strategies of preventing and treating HCV infection in MHD patients could improve the prognosis of this population [8]
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