The read me drug was suitably tolerated by patients. Flu-like syndrome, throbocytopenia, leucopenia, and anemia were the most frequent side-effects and were experienced in nine patients (53%). These side-effects included flu-like syndrome in eight (47%), fatigue in six (35%), anemia in four (23.5%), thrombocytopenia in three (17.6%), and leucopenia in three of them (17.6%). We had to stop the treatment in five patients (22.7%) in fourth month at the begin of the treatment due to complications (two of anemia, two of weakness, one of gastrointestinal bleeding). The side-effects led to discontinuation of the treatment in five patients. Seventeen of 22 patients finished the treatment in spite of side-effects due to PEG-IFN. No patient had a serious infection during the treatment period.

DISCUSSION In patients with normal renal function, pegylation increases the size of the molecule, delays its clearance, and enhances the therapeutic effect of standard IFN. It is possible to hypothesize that, in patients with renal failure; the clearance of PEG-IFN would be even more delayed, resulting in higher serum levels of the drug and in a longer half-life time. The results of this study confirm the efficacy and safety of PEG-IFN therapy in hemodialysis patients with chronic hepatitis C. Treatment for 48 wk with PEG-IFN resulted in sustained virologic responses in 64.7% of patients. HCV infection increases the risk of death in patients on chronic hemodialysis, along with hepatocellular carcinoma and liver cirrhosis[16].

Many controlled and uncontrolled trials have focused on the treatment of chronic hepatitis C patients on chronic haemodialysis with IFN therapy[17], because treatment with PEG-IFN is rarely recommended. Fabrizi et al have found a mean SVR of 37% in chronic hepatitis C patients on dialysis after IFN therapy. Sustained biochemical and virological response rates in patients under classical IFN therapy were reported as 0%-67% and 15.8%-64%, respectively[6]. Sporea et al have found, in treatment of these patients with standard IFN the sustained biochemical response of 46.1% and sustained virological response of 38.4% respectively 6 mo after interferon treatment[17]. The promising results at the standard IFN therapy in chronic haemodialysis patients with chronic hepatitis C, have shown that viral clearance occurs in 27%-64% of patients after 12 mo of treatment with standard IFN[18,19].

Patients with end-stage renal disease and chronic hepatitis C might have severe chronic hepatitis despite normal serum liver enzyme activity[20]. In our study, serum ALT levels were normal in 36.4% of the patients at the beginning of the study. Similarly, Perez et al reported normal ALT levels in 49% of patients at the beginning Entinostat of treatment[20]. In the treatment group in our study, serum ALT levels became normal in 71.4% of the patients by the end of the therapy, whereas 16.