Long term changes in thrombocytopenia and leucopenia after HCV eradication with direct-acting antivirals

Abstract

Background Thrombocytopenia due to hypersplenism is a major complication of hepatitis C virus (HCV)-associated cirrhosis. HCV eradication improves these complications in some patients, but the long-term effects of HCV eradication on these complications remain unclear, especially in patients treated with direct acting antivirals (DAAs). The aim was to evaluate long term changes in thrombocytopenia and leucopenia after HCV eradication with DAAs. Methods The present multicenter study retrospectively evaluated changes over 5 years in thrombocytopenia and leukocytopenia, as well as changes in liver fibrosis markers and spleen size, in 115 patients with HCV-cirrhosis treated with DAAs. Results Thrombocytopenia and leukocytopenia were improved 4 weeks after DAA administration, with thrombocytopenia show further gradual improvement over the next year. Fib-4 index was markedly reduced 1 year after DAA, followed by subsequent gradual reduction over the next 4 years. Spleen size showed gradual annual reductions, with patients experiencing spleen size reduction characterized at baseline by bilirubinemia. Conclusions Rapid DAA-associated HCV eradication might lead to rapid disappearance of liver inflammation and bone marrow suppression due to HCV infection. HCV eradication may gradually improve portal hypertension, reducing spleen size.

Pattern and burden of thrombocytopenia in chronic hepatitis C virus patients at a tertiary care hospital

“…In individuals with chronic hepatitis, it is commonly observed, especially among HCV antibodies positive individuals, who are 2.6 times more likely to have a low platelet count compared to HCVantibody negative individuals [1]. This drop in platelet count can often be the sole indication of viral hepatitis, leading to consideration of it as a potential cause in the differential diagnosis of primary immune thrombocytopenia (ITP) [2]. The underlying causes are varied, involving aspects like autoimmunity, direct bone marrow suppression, hypersplenism, diminished thrombopoietin production, and adverse effects of therapy [5].…”