Hepatitis C, Chronic Clinical Trial
Official title:
Treatment of Hepatitis C Virus Infection With Direct-acting Antiviral Drugs in Patients With Hemoglobinopathies
Progression of liver fibrosis in patients with hemoglobinopathies is strongly related to the severity of iron overload and the presence of chronic hepatitis C virus (HCV) infection. Effective iron chelation therapy and HCV infection eradication are efficacy to prevent liver complications. EASL and AASLD guidelines recommend interferon-free regimens for the treatment of HCV infection in patients with hemoglobinopathies. However, data regarding the use of direct-acting antiviral drugs (DAAs) in this patient population are very few This large, observational study evaluated the safety and efficacy of standard therapy with DAAs in a large Italian cohort of with hemoglobinopathies, chronic HCV infection and advanced liver fibrosis.
Many patients with hemoglobinopathies have been infected with hepatitis C virus (HCV)
through blood transfusion, mostly before screening of blood donors was introduced in 1992.
The reported prevalence of anti-HCV-positive thalassemia patients varies between 4.4% in
Turkey and 85.4% in Italy. HCV infection is associated with decompensated cirrhosis,
hepatocellular carcinoma and other liver complications, especially if left untreated.
Prevalence of cirrhosis in thalassemia patients up to 32% have been reported.
Thalassemia patients with cirrhosis have an increased risk of death. Progression of liver
fibrosis is strongly related to the presence of chronic HCV infection and extent of iron
overload. Thalassemia patients with elevated serum aminotransferase levels for >6 months
should be tested for HCV infection and, in the event of HCV infection, HCV genotyping is
recommended in order to plan antiviral therapy and the likelihood of response. Noninvasive
transient elastography (FibroScan®) can be used to determine the presence of fibrosis in
thalassemia patients with HCV infection.
Effective chelation therapy and treatment of HCV infection are needed in order to prevent
liver complications and decrease morbidity and mortality. For many years, pegylated
interferon (peg-IFN) plus ribavirin was the standard of care for the treatment of chronic
HCV infection and decompensated cirrhosis. Studies of peg-IFN plus ribavirin have
demonstrated sustained virological response (SVR) rates of 25−64% in patients with
thalassemia and HCV infection. However, peg-IFN and ribavirin are both associated with
anemia. Ribavirin-associated hemolysis leads to an increased requirement for blood
transfusions, which in turn can lead to worsening of iron overload. Therefore, European
Association for the Study of the Liver (EASL) 2015 guidelines recommend interferon-free
regimens for the treatment of HCV infection in patients with hemoglobinopathies. The aim of
this study was to evaluate the safety and efficacy of DAA standard regimens in patients with
hemoglobinopathies and chronic HCV liver disease treated in Italy.
Antiviral treatments were administered according to Italian Medicines Agency (AIFA)
guidelines.
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