Effectiveness and Safety of Direct Acting Antiviral Agents in Thalassaemic Patients With Chronic Hepatitis C

Abstract

Background: Pakistan has the highest prevalence of Β-Thalassemia major in children and Chronic Hepatitis C (HCV) infection is a common transfusion transmitted infection. After the emergence of new generations of Antiviral drugs labelled as Direct Acting Antivirals (DAAs), substantial eradication of HCV has been reported as 90–95% with fewer side effects as compared to older regimen of Peginterferon with or without Ribavirin. The main objective of this study was to assess the Rapid virological response (RVR) at 4th week, End of treatment response (ETR) at 12th week and sustained viral response (SVR) at 24th week achieved by using direct acting antiviral and to assess their safety. Methods: Retrospective descriptive study was conducted from July 2018 to July 2020 at National Institute of Child Health. All β-thalassemia major paediatric patients with HCV infection and age between 3–14 years were included. Demographic data, liver function test, HCV PCR, and response of antiviral therapy was recorded and analyzed. Safety was determined by adverse effects reported in records and efficacy was documented by clearance of HCV-RNA to see ETR and SVR. Results: Total 21 patients were treated. Mean age was 7.67±3yr and 12 (57%) were male. Mean weight was 19.3±3.2kg. RVR and ETR was achieved in all (100%) and SVR was achieved in 20/21 (95%) patients. Headache in 2(9.5%) and generalized body ache was found in 1 (4.25%) patient. Conclusion: Combined Sofosbuvir and Daclatasvir were found to be effective and safe for treating HCV in Thalassaemia Major Children.

Usefulness of Sofosbuvir and Daclatasvir combination in the treatment of HCV infection in childhood cancer patients: experience from a tertiary care hospital

“…24 In the paediatric population, encouraging results regarding the use of DAAs including the SOF-DAC combination are available, indicating their positive efficacy and favourable safety profiles. 15,25 Nothing, however, has been published for this special subset of patients with childhood cancer that is likely to receive multiple injectable medications and repeated blood transfusions during the illness and treatment. In the current study, there were 5 children aged <5 years.…”

Hepatitis C and Thalassemia: A Story with (Almost) a Happy Ending

“…Experiences with DAAs in patients with thalassemia have been reported worldwide [ 72 , 73 ]. Commonly, the patients treated in resource-limited countries are children or adolescents with results comparable to the adults [ 74 , 75 , 76 ]. Given the excellent global results of the DAAs, with outcome equally positive in patients with no iron and with moderate or severe liver iron overload, the role of hepatic siderosis in conditioning SVR seems extremely unlikely.…”

An Update on National Consensus Practice Guidelines for the Treatment of Hepatitis C & Literature Review in Epidemiology of Hepatitis C in Pakistan - 2022

“…Arit Parkash et al also evaluated the safety of DAAs in 21 thalasemia patients with efficacy of 95%(20/21). There were rare side effects as only 2 patients had headache and 1 reported body aches [139]. Most of the patients in HCV mono-infected group (76.2%) did not require any drug modification as compared to HCV/HIV (24.2%) and HCV/CKD group (17.1%) [140]…”