TREATMENT
OF CHRONIC HEPATITIS C IN THALASSAEMIA MAJOR
Li CK1, Chan PKS1,
Ling SC2, Luk CW3, Ha SY5
1Prince of Wales
Hospital, The Chinese University of Hong Kong, 2Princess
Margaret Hospital, 3Queen Elizabeth Hospital, 4Queen
Mary Hospital, Hong Kong, China
Objectives: To study the efficacy
and side effects of combination treatment for chronic hepatitis C (HCV) infection
in Chinese thalassaemia major (TM).
Methods: A multicentre prospective
single arm study of using standard treatment protocol for HCV was conducted
in Hong Kong. TM patients were eligible if they were positive for anti-HCV
and HCV-RNA, with persistent elevation of liver enzyme (ALT) for at least 6
months, and liver biopsy showed chronic hepatitis. Patients were treated
with interferon a (Intron A) at 3 miu/m2 subcutaneous
3 times per week, and ribavirin 16 mg/kg/day oral (round up to nearest 200
mg tablets). The treatment lasted for one year. Liver enzymes were
monitored monthly before regular blood transfusion (biochemical response)
and HCV RNA was monitored 3 monthly during and up to 6 months after
stopping treatment (virological response).
Results: 18 TM patients were
recruited with median age 16.4 years (range 7.2 ¨C 28.8), 10 males and 8
females. Genotype study showed 15 were of genotype 1b and 3 of genotype 6a.
The HCV RNA levels at start of treatment were <5000 copies/ml in 6
patient, and >100000 copies/ml in 6 patients, and the others were in
between. Biochemical response with normalisation of ALT were noted in 15
patients (83%) and mostly at 4 weeks of treatment and 3 non-responders all
had persistent HCV infection. 17 patients had completed one year treatment
and 12 had been followed up to 6 months after stopping treatment. The
virological response at 3, 6, 12 months during treatment and 6 months after
stopping treatment were 73%, 75%, 70% and 75% respectively. The blood
consumption during treatment was increased by 30% and the body weight
decreased by 6.6%. Leukopenia occurred in 39% and thrombocytopenia in 17%,
dose reduction was required in 22%. Other common side effects included
fever, fatigue, headache, bone pain and anorexia.
Conclusion: Interferon and
ribavirin combination achieved a high biochemical and sustained virological
response in Chinese TM patients. Ribavirin treatment was associated with a
significant haemolysis requiring increased blood transfusion requirement.