THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY.
Background/Aims: The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression and management of recently acquired HCV in pati...
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PAGEPress Publications
2019-10-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | http://mjhid.org/index.php/mjhid/article/view/4046 |
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| author | Sanaa Kamal Sara Abdelhakam, Dr. Dahlia Ghoraba Mohamad Amer Mohsen Ahmed Abdelsalam Huda Hassan Leila Nabeigh |
| author_facet | Sanaa Kamal Sara Abdelhakam, Dr. Dahlia Ghoraba Mohamad Amer Mohsen Ahmed Abdelsalam Huda Hassan Leila Nabeigh |
| author_sort | Sanaa Kamal |
| collection | DOAJ |
| description | Background/Aims: The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression and management of recently acquired HCV in patients with transfusion dependent thalassemia major versus acute HCV without thalassemia.
Methods: A well-characterized cohort of patients with thalassemia and recent HCV infection or recent HCV without thalassemia were enrolled and prospectively followed. The blood transfusion needs and chelating agents were determined. Liver functions tests, HCV-RNA, iron and ferritin levels were measured. Patients with chronic HCV evolution received treatment for HCV. The fibrosis progression rate was determined in chronic HCV patients with or without thalassemia by paired liver biopsies or serial transient elastography (TE), or serum markers of liver fibrosis. Liver iron content (LIC) was assessed by R2 MRI.
Results: Self-limited acute HCV was observed in 17% of patients with acute HCV and thalassemia versus 35% of patients without thalassemia (P=0.031). The fibrosis progression rates were significantly higher in patients with chronic HCV and thalassemia compared to those with chronic HCV alone (1.14±0.48) and (0.35±0.14) (P < 0.0001) respectively. A direct linear correlation was observed between the fibrosis progression rate and each of LIC (R=+0.67; P=0.01) and ferritin (R=0.77; P<0.01). In patients with chronic HCV and thalassemia, the sustained virologic response (SVR) to pegylated interferon based therapy and direct antiviral agents (DAAS) were 33% and 82% respectively (P=), while in chronic HCV patients without thalassemia, the SVR rates to PEG-IFN/RBV and DAAs were 51% and 92% respectively. Five patients with concomitant HCV and thalassemia died during the study due to cardiac causes (n=3) and liver cancer (n=2).
Conclusions: Patients with acute HCV and thalassemia have low rates of spontaneous resolution of HCV infection and the majority develop chronic HCV. Direct acting antiviral combinations are associated with high SVR rates and low adverse event in treatment naïve and experienced patients with chronic HCV and thalassemia. Liver fibrosis is accelerated in thalassemia patients with chronic HCV, therefore, early diagnosis, treatment with DAAs, adequate iron chelation and non-invasive monitoring liver status are recommended to prevent cirrhosis and hepatocellular carcinoma. |
| format | Article |
| id | doaj-art-50b1e3957ff142478ae257d6fa5964ed |
| institution | DOAJ |
| issn | 2035-3006 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | PAGEPress Publications |
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| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-50b1e3957ff142478ae257d6fa5964ed2025-08-20T02:58:44ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062019-10-0111110.4084/mjhid.2019.060THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY.Sanaa Kamal0Sara Abdelhakam, Dr.1Dahlia Ghoraba2Mohamad Amer Mohsen3Ahmed Abdelsalam4Huda Hassan5Leila Nabeigh6Ain Shams University/Tufts Medical SchoolAin Shams Faculty of MedicineAin Shams Faculty of MedicineDepartment of Radiodiagnosis, Misr University of Science and Technology, Cairo, EgyptDepartment of Pediatrics, Misr University of Science and Technology, Cairo, Egypt4Department of Hematology and Clinical pathology, Faculty of Medicine, Cairo University, Cairo, EgyptDepartment of pathology, Ain Shams Faculty of Medicine, Cairo, EgyptBackground/Aims: The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression and management of recently acquired HCV in patients with transfusion dependent thalassemia major versus acute HCV without thalassemia. Methods: A well-characterized cohort of patients with thalassemia and recent HCV infection or recent HCV without thalassemia were enrolled and prospectively followed. The blood transfusion needs and chelating agents were determined. Liver functions tests, HCV-RNA, iron and ferritin levels were measured. Patients with chronic HCV evolution received treatment for HCV. The fibrosis progression rate was determined in chronic HCV patients with or without thalassemia by paired liver biopsies or serial transient elastography (TE), or serum markers of liver fibrosis. Liver iron content (LIC) was assessed by R2 MRI. Results: Self-limited acute HCV was observed in 17% of patients with acute HCV and thalassemia versus 35% of patients without thalassemia (P=0.031). The fibrosis progression rates were significantly higher in patients with chronic HCV and thalassemia compared to those with chronic HCV alone (1.14±0.48) and (0.35±0.14) (P < 0.0001) respectively. A direct linear correlation was observed between the fibrosis progression rate and each of LIC (R=+0.67; P=0.01) and ferritin (R=0.77; P<0.01). In patients with chronic HCV and thalassemia, the sustained virologic response (SVR) to pegylated interferon based therapy and direct antiviral agents (DAAS) were 33% and 82% respectively (P=), while in chronic HCV patients without thalassemia, the SVR rates to PEG-IFN/RBV and DAAs were 51% and 92% respectively. Five patients with concomitant HCV and thalassemia died during the study due to cardiac causes (n=3) and liver cancer (n=2). Conclusions: Patients with acute HCV and thalassemia have low rates of spontaneous resolution of HCV infection and the majority develop chronic HCV. Direct acting antiviral combinations are associated with high SVR rates and low adverse event in treatment naïve and experienced patients with chronic HCV and thalassemia. Liver fibrosis is accelerated in thalassemia patients with chronic HCV, therefore, early diagnosis, treatment with DAAs, adequate iron chelation and non-invasive monitoring liver status are recommended to prevent cirrhosis and hepatocellular carcinoma.http://mjhid.org/index.php/mjhid/article/view/4046hepatitis C, thalassemia, liver fibrosis progression, transient elastography, serum fibrosis markers |
| spellingShingle | Sanaa Kamal Sara Abdelhakam, Dr. Dahlia Ghoraba Mohamad Amer Mohsen Ahmed Abdelsalam Huda Hassan Leila Nabeigh THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. Mediterranean Journal of Hematology and Infectious Diseases hepatitis C, thalassemia, liver fibrosis progression, transient elastography, serum fibrosis markers |
| title | THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. |
| title_full | THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. |
| title_fullStr | THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. |
| title_full_unstemmed | THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. |
| title_short | THE COURSE OF HEPATITIS C INFECTION AND RESPONSE TO ANTI-VIRAL THERAPY IN PATIENTS WITH THALASSEMIA MAJOR AND HEPATITIS C INFECTION: A LONGITUDINAL, PROSPECTIVE STUDY. |
| title_sort | course of hepatitis c infection and response to anti viral therapy in patients with thalassemia major and hepatitis c infection a longitudinal prospective study |
| topic | hepatitis C, thalassemia, liver fibrosis progression, transient elastography, serum fibrosis markers |
| url | http://mjhid.org/index.php/mjhid/article/view/4046 |
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