Iranian Journal of Public Health 2017. 46(10):1386-1394.

Treatment Related Hematologic Changes in a Population of Iranian Patients with Chronic Hepatitis C Infection from 2009 to 2014
Zahra AHMADINEJAD, Zahra ABDILIAEI, Rizan MOHAMADI, Omid REZAHOSSEINI

Abstract


Abstract

Background: We aimed to assess the frequency of hematologic changes, response to treatment, rate of discontinuation and dose reduction in Hepatitis C positive patients, treated with Interferon and ribavirin from Apr 2009 to Mar 2014.

Methods: In this cross-sectional study, out of registered patients, 554 were assessed and 150 patients with positive HCV PCR, regular patient visits to clinic and complete records were included. HCV viral load, complete blood count and liver enzyme levels were measured before initiation of treatment and monthly.. Exclusion criteria's were other types of hepatitis and HIV infection, autoimmune or blood diseases, illegal drug use and treatment with bone marrow suppressors. The data was analyzed using SPSS.

Results: Out of 150 patients, 135 (90%) were male. Mean age was 39.7± 10.7 (range 23-74) yr old. Forty-six patients (30.7%) had genotype 1 and 99 (66%) genotypes 2 and 3. Treatment regimens were prescribed as Pegafron+Ribavirin in 125 (83.3%), Interfron+Ribavirin 9 (6%) and Pegintron+Ribavirin in 16 (10.7%) of patients... The prevalence of anemia in genotype 1 patients was higher (P=0.044). There was no association between sex and leukocyte changes.  Thirty-four (22.7%) patients had moderate and severe thrombocytopenia. Six patients had severe anemia and Ribavirin dose was adjusted.

Conclusion: The hematological changes are common side effects of conventional hepatitis C treatment regiments. Although drug dose adjustment is not usually necessary, due to severe anemia in genotype 1 patients, we should treat high-risk patients cautiously and made the appropriate changes in drug dosage at the right time.

 

 


Keywords


Interferon, Ribavirin, Leukopenia, Anemia, Thrombocytopenia, Hepatitis C, Genotype

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References


Khodabandehloo M, Roshani D (2014). Prevalence of hepatitis C virus genotypes in Iranian patients: a systematic review and meta-analysis. Hepat Mon, 4(12):e22915.

Li HC, Lo SY (2015). Hepatitis C virus: Virology, diagnosis and treatment. World J Hepatol, 7(10): 1377-89.

Seeff LB (2002). Natural history of chronic hepatitis C. Hepatology. 36: S35-46.

Strader DB, Wright T, Thomas DL, Seeff LB (2004). American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C. Hepatology, 9(4):1147-71.

Fried MW (2002). Side effects of therapy of hepatitis C and their management. Hepatology , 36:S237-244.

Roomer R, Hansen BE, Janssen HL, de Knegt RJ (2010). Risk factors for infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.Hepatology, 52(4):1225-31.

Serrano-Villar S, Quereda C, Moreno A, Pérez-Elías MJ, Casado JL, Royuela A, Dronda F, Navas E, Hermida JM, Moreno S (2013). Neutropenia during therapy with peginterferon and ribavirin in HIV-infected subjects with chronic hepatitis C and the risk of infections. Clin Infect Dis, 57(3):458-64.

Antonini MG, Babudieri S, Maida I, Baiguera C, Zanini B, Fenu L, Dettori G, Manno D, Mura MS, Carosi G, Puoti M (2008). Incidence of neutropenia and infections during combination treatment of chronic hepatitis C with pegylated interferon alfa-2a or alfa-2b plus ribavirin. Infec-tion, 36(3):250-5.

van den Berg CH, Grady BP, Schinkel J et al (2011). Female sex and IL28B, a synergism for spontaneous viral clearance in hepatitis C virus (HCV) seroconverters from a community-based cohort. PLoS One, 6(11):e27555.

Grebely J, Page K, Sacks-Davis R et al (2014). The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology, 59(1):109-20.

Berghöfer B, Frommer T, Haley G, Fink L, Bein G, Hackstein H (2006). TLR7 ligands induce higher IFN-alpha production in females. J Immunol, 15; 177(4):2088-96.

Fried MW, Shiffman ML, Reddy KR et al (2002). Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med, 26;347(13):975-82.

Sun LJ, Yu JW, Kang P, Zhao YH, Yan BZ (2012). A study of the relationship between neutropenia and clinical infection risk during treatment with peginterferon alfa-2a and ribavirin for chronic hepatitis C. Zhonghua Nei Ke Za Zhi,51(1):46-50.

Ong JP, Younossi ZM (2004). Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: anemia, neutropenia, and thrombocytopenia. Cleve Clin J Med, 71 ; 3:S17-21.

Sulkowski MS (2003). Anemia in the treatment of hepatitis C virus infection. Clin Infect Dis, 37: S315-22.

McHutchison JG, Gordon SC, Schiff ER, Shiffman ML, Lee WM, Rustgi VK, Goodman ZD, Ling MH, Cort S, Al-brecht JK (1998). Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med, 339(21):1485-92.

Poynard T, Marcellin P, Lee SS, Niederau C, Minuk GS, Ideo G, Bain V, Heathcote J, Zeuzem S, Trepo C, Albrecht J (1998). Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT). Lancet, 31:1426-32.

Chang CH, Chen KY, Lai MY, Chan KA (2002). Meta-analysis: ribavirin-induced haemolytic anaemia in patients with chronic hepatitis C. Aliment Pharmacol Ther, 16(9):1623-32.

Dieterich DT, Spivak JL (2003). Hematologic disorders associated with hepatitis C virus infection and their management. Clin Infect Dis, 37(4):533-41.

Manns MP, McHutchison JG, Gordon SC et al (2001). Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet, 22; 358(9286):958-65.

Garcí¬a-Suárez J, Burgaleta C, Hernanz N, Albarran F, Tobaruela P, Alvarez-Mon M (2000). HCV-associated thrombocytopenia: clinical characteristics and platelet response after recombinant alpha2b-interferon therapy. Br J Haematol, 110(1):98-103.

Lin KH, Hsu PI, Yu HC, Lin CK, Tsai WL, Chen WC, Chan HH, Lai KH (2012). Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts. BMC Gastroenterol,18;12:7.

Kowdley KV (2005). Hematologic side effects of interferon and ribavirin therapy. J Clin Gastroenterol, 39:S3-8.


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