الفهرس 
HCV InfectionOnly 14 pages are availabe for public view
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Abstract
The World Health Organization has declared hepatitis (C) global health problem with approximately 3% of world population (roughly 170-200 million people) infected with HCV. In Egypt, the situation is quite worse as it has the highest prevalence of HCV in the world, 12-13%, and interestingly genotype 4 HCV represents over 90% of cases. The recommended combination therapy of pegylated IFN and ribavirin for chronic HCV for 48 weeks increased SVR rates to almost 40%. Pegylated interferon and ribavirin together with HCV itself have been reported to cause multiple hematological side effects that result in high rates of dose reduction and discontinuance of treatment. Among these are anemia, neutropenia and thrombocytopenia .
To fulfill the aim of the work, this study was designed to assess the prevalence and incidence of hematological side effects of combined pegylated interferon and ribavirin in treatment of HCV infection and the impact of these hematological side effects on the ETR, RVR, EVR and SVR during the combined therapy.
This study was conducted in the Interferon Unit of Sohag Liver and Cardiac Center-Ministry of Health, in the period from January 2009 to January 2011. Among 1000 cases of chronic HCV infection attended to Center, the study group; included only (300) patients who fulfilled the pre-designed inclusion criteria. All patients were subjected to the following; careful history, thorough clinical examination and laboratory investigations [liver enzymes (AST and ALT), serum albumin, INR, total and direct bilirubin, complete blood picture, viral markers (HCV-Ab, HBsAg, quantitative & qualitative HCV-PCR), glucose profile, TSH, pregnancy test, ANA and AFP. As well as, Abdominal ultrasonography and liver biopsy were done to all cases, to assess the liver staging and grading according to Metavir classification
All the recruited patients were treated by combined therapy of pegylated IFN alpha (Pegassys 180 µg\SC\week) and ribavirin (standard weight-based dose 1000 or 1200 mg\day orally) for 48 weeks. This was according to the guidelines of Egyptian ministry of health and population. Recording of the haematological side-effects of the combined therapy by follow-up CBC of the studied cases weekly at the first month, then at week 12, 24, and 48.
The results of the current study showed that HCV infection commonly occurs during the third decade of life(42.8±8.6)and is more predominant in males (52.0%). In the current study, the prevalence of anemia was 84.7% (254 patients), neutropenia was 54.7% (164 patients) and thrombocytopenia was 54.7% (164 patients). The incidence of occurrence of hematological side effects was 39.8% (101 patient) at < 4weeks, 21.3% (54 patients) at 4-weeks, 28.0% (71patients) at12-weeks and 11.0% (28 patients) at 24-48 weeks.
Regarding the virological response of the combined therapy, the responder (SVR) was 208 patients (69.3%), the non-responder (at wk 12 and wk 48) was 43 patients (14.3%) and the relapsers (at wk 72) was 49 patients (16.3%)
Having Hematological side effects mostly anaemia was significantly more frequent in non-responder cases (97.7%), mainly in the first 4 wk, and about 127 patients (71.8%) of the responder group having anemia were treatable and only 22 patients (52.4%) of the non-responder group were treatable In the present study, lower basal HCV RNA was a significant factor for being responder. The lower the HCV RNA (viral load), the better the chance of eradicating the hepatitis C virus.
Applying this to clinical practice, Adequate monitoring of hematological side-effects of combined pegylated interferon and ribavirin therapy in treatment of Egyptian HCV infected patients, might be used to identify candidates for early intervention against anemia in order to help maintain ribavirin dosing and avoid suboptimal exposure. This can necessitate a more frequent follow up sessions.