Mon, 18 Dec 2017

Hematological Side effects of Anti-viral Therapy in Egyptian Patients with Chronic Hepatitis C Virus

Hanan Abdel Hafez1*, Mohamed El Beshlawy1, Mahasen Mabrouk1, Wafaa El-Akel1, Tahany Awad1,2, Naglaa Zayed1, Gamal Esmat1.

1Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.

2.Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Rigshospitalet, Copenhagen, Denmark


ABSTRACT

Haematological complications (neutropenia, thrombocytopenia and anaemia) of pegylated interferon/ribavirin(PEG-IFN/RBV) in chronic hepatitis C can result in treatment cessation and suboptimal results. To investigate the nature, frequency of haematological side effects in the treatment of chronic hepatitis C infection and their impact on the response to PEG-IFN/RBV therapy. This cross sectional study of 3719 Egyptian patients with chronic HCV (genotype 4), who were received PEG-IFN/RBV therapy at Cairo-Fatemic Hospital, Egypt in the context of the national program was retrieved. Patients were defined as having hematological abnormalities if they had the presence of either/or a combination of following hematological parameters at least once during follow up period; drop in hemoglobin(Hb) level <10gm/dl, absolute neutrophil count(ANC)<750 cells/mm3, and platelet(PLT)count<80 x 103/µL. At week 48, end of treatment response (ETR) was 61.6% and at week 72 the estimated sustained virological response (SVR) was 52.5%. Pre-treatment, Hb, white blood cell (WBCs)count, ANC, and PLT count; were not statistically related to the treatment response. However lower count of all parameters were associated with moderate or advanced hepatic fibrosis stages according to the METAVIR scoring (p<0.001). During anti-viral therapy, anaemia occurred in 31.8%, neutropenia in 22.3% while thrombocytopenia occurred in 10.5%. Univariate logistic regression analysis showed that drop in Hb, TLC and PLT count were significantly associated with response to treatment; p value < 0.01, 0.03,0.03 respectively. Baseline hematological parameters were not predictors of treatment response in chronic HCV (genotype 4); however; low Hb level, TLC, ANC, and PLT count were associated with advanced stages of hepatic fibrosis. Drop of Hb,TLC and PLT count during anti-viral therapy were significantly associated with response rates regardless to the type of PEG-IFN.

Keywords: HCV; IFN; Ribavirin, Haemtological, Anaemia, platelet and neutopenia.


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