Effect of Direct-Acting Antiviral Therapy on Thrombocytopenic Patients with Hepatitis C Virus-Related Chronic Liver Disease

Abstract

Background and Aims. Thrombocytopenia is a common complication in patients with chronic hepatitis C virus (HCV) that increases the risk of bleeding. We aimed to analyze the hematologic effects of the new direct-acting antiviral (DAA) therapy, particularly on the platelet count in chronic HCV-infected patients with thrombocytopenia. Patients and Methods. One hundred thrombocytopenic patients chronically infected with HCV were included in a prospective study. All patients were eligible for receiving anti-HCV treatment with sofosbuvir-based regimens for 12 weeks, according to the protocol of the National Program for treatment of HCV in Egypt sponsored by the Ministry of Health. Results. At the end of treatment (EOT), there was a highly significant increase in platelet count ( p < 0.001 ), a significant increase in white blood cells (WBCs) count ( p ≤ 0.032 ), and a highly significant decrease in hemoglobin level ( p < 0.001 ) as compared to pretreatment levels. Patients with mild to moderate hepatic fibrosis had significantly higher median and interquartile range (IQR) platelet count at baseline and EOT than those with advanced fibrosis and cirrhosis ( p ≤ 0.023 and p < 0.001 , respectively). There was more elevation in platelet count at EOT in patients with mild to moderate fibrosis than those with advanced fibrosis and cirrhosis. Out of the hundred patients, 73% showed improvement of platelet count, while 27% showed no improvement or even decrease in the platelet count. Conclusion. Sofosbuvir-based DAA therapy is a highly effective and safe treatment regimen that results in the improvement of platelet count in thrombocytopenic patients, particularly in mild to moderate stages of hepatic fibrosis.

Neuropsychiatric and Laboratory Outcomes of Hepatitis C Treatment in an Early-Treated HIV Cohort in Thailand

“…The levels of liver enzymes decreased post-DAA, re ecting the resolution of HCV-related hepatic in ammation. Previous studies reported increases in hemoglobin levels, total leukocyte counts, and platelet counts after SVR [20][21][22], but these changes were not observed here. The hematological bene ts reported in prior studies could be secondary to improvements in liver brosis, portal hypertension, and anemia associated with chronic illness after SVR [23].…”

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

“…Thrombocytopenia is a common complication in chronic HCV infection, causing an increased risk of bleeding[ 94 , 95 ]. The prevalence and severity of thrombocytopenia increase with the progression of liver disease and the development of hepatocellular damage and hepatic fibrosis[ 96 ].…”

“…Chen et al [ 97 ] found that 99.6% of chronic HCV infected patients with thrombocytopenia receiving DAA treatment achieved a SVR and thrombocytopenia improved significantly in 41.7% of them. Another study reported a highly effective and safe DAA regimen, with improvement of platelet count in 73% of thrombocytopenic patients, especially in mild to moderate stages of hepatic fibrosis[ 95 ].…”