Dear Editor:
I've recently seen a 64 year old male with recently Dx renal
failure cc approx. 15-20, DM, and presumed cirrhosis based on LS scan with
ascites. Serology indicated he has type
2b viral load 136 K. My own feeling is
that with his comorbidities, cirrhosis and age, a durable remission or cure
would be unlikely with interferon alone.
Have you used ribavirin in CRF with dose adjustment? Is interferon alone
worth trying? I would appreciate any insights.
G.
Dear Dr. GS:
I share your conservative viewpoint regarding antiviral therapy, even though he
has genotype 2b - more favorable in terms of the likelihood of a sustained
virological response (SVR). Your patient is older, has cirrhosis that is
decompensated, and has renal failure. The overall chance of an SVR with
peginterferon monotherapy for one year in the pivotal trials was 25% with Peg-Intron
(Lindsay, Hepatology, 2001) and 39% with Pegasys (Zeuzem, N Engl J Med, 2000).
I have not personally used ribavirin in patients with this degree of renal
failure; my judgment is that it has substantial risk for drug-related toxicity.