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El Ashwah, S.1; Eisa, N.1; Ghoneem, E. A.2; El-Etreby, S.2

doi: 10.1097/01.HS9.0000568080.03077.74
Publication Only: Thalassemias

1Clinical Hematology Unit, Oncology Center

2Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

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Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassemic patients. Direct-acting antivirals agents (DAAs) are highly effective and well-tolerated by chronic HCV patients.

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This study was conducted to evaluate the safety and efficacy of DAAs in treatment of thalassemic patients with chronic HCV.

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This prospective study enrolled 22 thalassemic patients with chronic HCV infection proved by positive RT PCR HCV RNA from a total 40 patients who were positive for HCV ELISA test. Severity of liver disease was assessed in all patients. They received treatment of HCV according to guidelines of the National Committee for Control of Viral Hepatitis (NCCVH) in Egypt. About, 16 (72.72%) patients were treated with a sofosbuvir plus daclatasvir, and the other 6 (27.27 %) patients received sofosbuvir plus ledipasvir for 3 months. Primary end point was assessed by achievement of sustained virological response (SVR) at 12 weeks. Secondary end point was assessed by recording any side effects, transfusion requirements if need or stoppage of treatment.

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The mean age of our patients was 29 years and 50% of them were male. Only 2 (9.09%) of them had compensated cirrhosis. SVR 12 was achieved in all patients (100%). Only one case required treatment discontinuation for one week due to acute kidney injury after prolonged use of NSAIDs then resumed DAAs after decline of creatinine to normal value. The most common side effects were fatigue (18%), progressive anemia (13.63%), requiring blood transfusion that occurred in three of the patients who received sofosbuvir plus daclatasvir, and lastly, headache (4.5%). There was no statistically significant difference in the level of hemoglobin before and after DAAs (8.5 ± 1.34 gm/dl vs 8.6 ± 1.38 gm/dl with p value = 0.484). There was significant improvement of mean ALT values after treatment compared to baseline one (42.45 ± 18.56 vs 57.29 ± 35.07 with p value < 0.0005).

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Direct acting antiviral drugs namely sofosbuvir plus daclatasvir or sofosbuvir plus ledipasvir are safe, effective, and well tolerated regimens in thalassemic patients with chronic HCV.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.