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. 2017 Jan 1;9(1):e2017003.
doi: 10.4084/MJHID.2017.003. eCollection 2017.

Patients with Haemoglobinopathies and Chronic Hepatitis C: A Real Difficult to Treat Population in 2016?

Kalliopi Zachou  1 , Pinelopi Arvaniti  1 , Nikolaos K Gatselis  1 , Kalliopi Azariadis  1 , Georgia Papadamou  1 , Eirini Rigopoulou  1 , George N Dalekos  1
Affiliations

Patients with Haemoglobinopathies and Chronic Hepatitis C: A Real Difficult to Treat Population in 2016?

Kalliopi Zachou et al. Mediterr J Hematol Infect Dis. .

Abstract

Background & objectives: In the past, patients with haemoglobinopathies were at high risk of acquiring hepatitis C virus (HCV) due to multiple transfusions before HCV screening. In these patients, the coexistence of haemochromatosis and chronic hepatitis C (CHC) often leads to more severe liver disease. We assessed the HCV prevalence, clinical characteristics and outcome in this setting with particular attention to the response to treatment including therapies with the new direct acting antivirals (DAAs).

Methods: The medical records of 81 consecutive patients followed the last 15 years were reviewed retrospectively.

Results: 43/81 (53%) patients were anti-HCV positive including 31/43 (72.1%) with CHC (HCV-RNA positive; age 25±7 years; 45.2% with genotype 1b; 19.4% cirrhotics; baseline ferritin 887 ng/ml; range: 81-10.820). Thirty patients received IFN-based therapy with or without ribavirin with sustained virological response (SVR) in 14/30 (46.7%). Eleven patients (9 non-responders to IFN-based therapies, one in relapse and one naïve) received treatment with DAAs (SVR: 100%). 3/11 patients increased their transfusion needs while 1/11 reported mild arthralgias. No drug-drug interactions between DAAs and chelation agents were observed as attested by the stability of ferritin levels during treatment.

Conclusions: More than 1/3 of patients with haemoglobinopathies suffered from CHC. Response rates to IFN-based treatment seem to be similar to other patients with CHC, while most importantly, treatment with DAAs was excellent and safe even in difficult to treat patients (most null responders with severe fibrosis) suggesting that this group of HCV patients should no longer be regarded as a difficult to treat.

Keywords: DAAs; HCV; Thalassemic Syndromes; Treatment.

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Figures

Figure 1
Figure 1
Response to IFN-based therapy in 30 patients with haemoglobinopathies and chronic hepatitis C. SVR=sustained virological response, NR=no response.
Figure 2
Figure 2
Response to IFN-based therapy in 30 patients with haemoglobinopathies and chronic hepatitis C according to the number of treatment courses. SVR=sustained virological response, NR=no response.
Figure 3
Figure 3
Response to IFN-based therapy in 30 patients with haemoglobinopathies and chronic hepatitis C according to the kind of treatment schedule. SVR=sustained virological response, NR=no response, IFN=interferon alpha, PegIFN=pegylated interferon alpha, RBV=ribavirin.
Figure 4
Figure 4
Serum ferritin levels before and at the end of treatment with direct acting antivirals.
See this image and copyright information in PMC

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