The treatment of HCV in patients with haemoglobinopathy in Kurdistan Region, Iraq: a single centre experience

Direct Acting Antiviral Treatment for Patients with End-Stage Kidney Disease with Acute HCV Infection

BACKGROUND

Hepatitis C virus (HCV) infection is a public health problem. Such an infection is prevalent and aggressive in patients with end-stage kidney disease (ESKD). The efficacy and the safety of direct-acting antivirus (DAA) in patients with acute HCV and ESKD are under investigation. The aim of this study was to assess the safety and efficacy of sofosbuvir-containing regimens in this difficult-to-treat population.

METHODS

A prospective and observational study was conducted to evaluate the efficacy and the safety of sofosbuvir containing regimen in patients with ESKD who were undergoing haemodialysis and were acutely infected with HCV. Subjects either received sofosbuvir 200 mg and daclatasvir 60 mg daily or sofosbuvir 400mg/ledipasvir 60mg daily for 12 weeks.

RESULTS

19 Patients were recruited in this study who were infected with HCV genotype 1a. All subjects achieved a sustained virologic response (SVR) twelve weeks after finishing the treatment course. No significant adverse effects were reported, and the treatment course was well tolerated.

CONCLUSIONS

sofosbuvir-containing regimens were effective and safe for the treatment of acute HCV in patients with ESKD who were on haemodialysis.

The effectiveness of oral antiviral (Sofosbuvir/Ledipasvir) in treating children with HCV infection

OBJECTIVES

To determine the efficacy of (Sofosbuvir/ledipasvir) in treating children with HCV infection.

METHODS

This study was conducted at Gastroenterology, Hepatology Center /Pediatrics department and the Central Child Teaching Hospital, Baghdad / Iraq from April 2017 to January 2018. Patients with positive HCV PCR, aged 7 to 18 years were enrolled. History, clinical examinations and investigations were conducted. HCV genotyping was done (if affordable). Sofosbuvir/Ledipasvir was given to all patients once daily. Ribavirin was added for INF-experienced patients or with established cirrhosis. Follow up with liver function and renal function and PCR was done at 12 weeks (end of treatment); then after 12 weeks post treatment (SVR12). Total duration of therapy was 12 weeks, extended to 24 in cases with established cirrhosis. Computer program SPSS version 20 was used for data analysis.

RESULTS

The number of patients was 22, with mean age of 12.5 years, 14 boys (63.6%), and 8 girls (36.4%). Genotype 1 was the dominant type (75%). SVR 12 was achieved in 20 patients (90.9%), the remaining two (9.1%) had partial virological response. HBV co-infection was found in five cases; they were kept on Entecavir during the course of treatment. All achieved SVR12 for HCV with decrease in titer of HBV. Even INF-experienced patients (7 patients 31.8%) were responsive with SVR12. The treatment was well tolerated.

CONCLUSION

Sofosbuvir/ledipasvir is effective in treating HCV in children, and is well tolerated.

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

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.