ANEMIA IN EGYPTIAN CHRONIC HEPATITIS C PATIENTS: STUDY OF THE CAUSES PRIOR TO AND DURING INTERFERON/RIBAVIRIN VERSUS SOFOSBUVIR THERAPY
Journal Title: World Journal of Pharmaceutical and Medical Research - Year 2017, Vol 3, Issue 7
Abstract
Background: This study aimed to investigate types and underlying mechanisms of anemia in Egyptian chronic HCV patients prior to and during a variety of anti-HCV therapy protocols. Methods: We studied 210 anemic HCV patients (hemoglobin <13 g/dl in males and <12g/dl in females) divided into 4 groups: group A: 58 patients who did not receive treatment, group B: 61 patients who were receiving sofosbuvir and ribavirin [RBV], group C: 51 patients receiving sofosbuvir, RBV and Pegylated interferon [Peg-IFN], and group D: 40 patients on Peg-IFN/RBV therapy. Results: Hypersplenism was the most common cause of anemia (53.4%) in naïve HCV patients, followed by iron deficiency anemia [IDA] (32.8%), then anemia of chronic disease [ACD] (25.9%). In groups B, C and D; non immune hemolytic anemia (NIHA) mostly due to RBV was the commonest cause of anemia (77.0%, 49.7% and 52.5%; respectively), followed by hypersplenism (36.1%, 17.6% and 15.0%; respectively), followed by ACD (13.1%, 17.6% and 12.5%; respectively), and the least common was IDA (3.3%, 13.7% and 7.5%; respectively). Also, we diagnosed 8 cases of IFN-induced BM aplasia / hypoplasia ( patients in group and 3 in group In out of those cases severe cytopenias necessitated therapy discontinuation nexplained normochromic normocytic anemia mostly drug related was found in % of group % of group and 3 % of group D patients. Hypochromic microcytic anemia, hypersplenism and positive occult blood in stools were significantly higher in group A compared to other groups (p=0.0030, p=0.001 and p=0.036; respectively). Autoimmune hemolytic anemia (AIHA) was diagnosed in two patients; one (1.7%) in group A and one (2.5%) in group D. Non-Hodgkin's lymphoma NHL was diagnosed in two patients 3 % in group Severe anemia i e Hb≤ g/dl was more common in group D compared to other groups (p=0.029). Conclusion: We conclude that anemia of diverse etiology occurs in H patients prior to and during anti viral therapy lthough we met cases of unexplained therapy - related anemia in all patient groups receiving anti-viral therapy, yet sofosbuvir - containing regimens are associated with milder forms of anemia compared to the old IFN/RBV therapy protocol. We recommend regular and close follow up of HCV patients on anti-viral therapy for early diagnosis and prompt treatment of any decline in hemoglobin concentration.
Authors and Affiliations
Dr. Nadia El-Sayed Zaki
Keywords
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