Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection

Abstract

Article type: original ArticleBackground: Treatment of hepatitis C virus (HCV) infection with interferon (IFn) and ribavirin (RBV) is associated with adverse events, which may affect the patient's adherence to the treatment regimen and the treatment efficacy. Objectives: The aim of this study was to assess the sustained viral response (SVR) and interdependence between the haematological characteristics (leukocyte count, platelet count, and haemoglobin levels) in patients with chronic hepatitis C (CHC) infection during treatment with IFn and RBV. Patients and Methods:We conducted a retrospective cohort study of 170 children with CHC infection who completed treatment with IFn-α and RBV. The children were divided into 2 groups: the first group (group I, n = 119) underwent a 48-week course of treatment with recombinant IFn α-2b (Intron A) at a dosage of 3 MU 3 times a week subcutaneously and RBV at a dosage of 15 mg/kg per day orally, and the second group (group II, n = 51) was administered pegylated IFn (peg-IFn)-α-2b (pegIntron) at a dosage of 1.5 µg/kg per week subcutaneously and RBV at a dosage of 15 mg/kg per day orally for 48 weeks. The dose of IFn was not adjusted but that of ribavirin was in 2 children from group II. Hematological growth factors and erythropoietin were not used. SVR was defined as undetectable serum HCV RnA 24 weeks after the end of treatment (study week 72). Serum HCV RnA was determined by performing polymerase chain reaction, and the HCV genotypes and hematological parameters were evaluated. Serum HCV RnA levels were analysed by descriptive statistics. Means and standard deviations were calculated for values collected at the baseline, on the 12th and 48th weeks during treatment, and after 24 weeks of untreated follow-up (study week 72). Results: eighty-six (50%) of the 170 patients who underwent treatment achieved SVR: 62 (51%) out of 119 children from group I and 24 (47%) out of 51 from group II. The mean serum hemoglobin levels and leukocyte and platelet counts at week 12 were significantly lower than the baseline values in both responders and non-responders from both the groups (P < 0.05). In the responders in group I, the mean levels of serum hemoglobin after 24 weeks of treatment and at the end of therapy were significantly lower than the mean levels at baseline. In the group treated with peg-IFn-α-2b and RBV (group II), the mean serum hemoglobin levels at week 12 was lower in the responders than in the non-responders (P < 0.05). The decrease in the hemoglobin levels was associated with viral response. In both the responders and nonresponders from both the groups, leukocyte counts decreased during treatment, and after 12 weeks, they were more significantly lower than the baseline value. The decrease was more marked in children treated with peg-IFn-α-2b + RBV (P < 0.05). After 12 weeks of treatment, the platelet count was low in children from group II who had achieved SVR. Conclusions: A mild decrease in hemoglobin levels and leukocyte and platelet counts during treatment with IFn and ...

Hepatitis C Therapy – Related Haematological Side Effects are Associated with Treatment Outcome / Hematološka Neželjena Dejstva Terapije Hepatitisa C Su Povezana Sa Ishodom Lecenja

“…However, the Pt, WBC and Ne counts decreased in the SVR group, and they were significantly lower at the end of treatment in the SVR group compared with the NR/RR group. Our results are consistent with previous findings that leucopoenia and thrombocytopenia are significantly more pronounced in patients who achieved sustained virological response (8,25). We suggest that this difference is related to individual variations in pharmacokinetics and biochemical and physiological effects of drugs.…”

“…Some of these adverse effects can be severe and require modification of the therapy dosage or withdrawal from therapy. However, a previous study by Pawlowska et al showed that alterations in haematological parameters are associated with response to therapy (8).…”

Sustained Viral Response Hematological Markers During The Treatment of Chronic Hepatitis C Infection in Children

“…We read with interest the paper by Pawlowska et al (1) and we would like to add some comments. They conducted a retrospective cohort study of children with chronic hepatitis C (CHC) infection who completed treatment with ribavirin (RBV) plus pegylated IFN (peg-IFN) or recombinant IFN, and concluded that a mild decrease in hemoglobin levels , leukocyte and platelet counts during treatment may be the responsible factors for sustained viral response (SVR) induction.…”