Rapid increase of platelet counts during antiviral therapy in patients with hepatitis C virus infection

Abstract

The cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection is multifactorial: hypersplenism, decreased thrombopoietin levels, and myelosuppression induced by HCV. Platelet counts increase after eradication of HCV; however, this mechanism is not fully understood. Therefore, the aim of this study was to determine the influence of these three factors on platelet counts. Methods:We retrospectively analyzed data from 109 HCVinfected patients with platelet counts ≤150 × 10 3 /μL who achieved viral eradication using interferon-free anti-HCV therapy. Changes in hematological parameters, thrombopoietin levels, HCV titers, and spleen volumes, and the correlations among them were evaluated.Results: HCV RNA levels significantly decreased at 4 weeks after initiating antiviral therapy. Platelet counts rapidly increased at 4 weeks from baseline (120 ± 35 vs. 106 ± 28 × 10 3 /μL, P < 0.001), and remained at a plateau until 48 weeks after initiating antiviral therapy. Neutrophil counts showed the same pattern. Spleen volume was evaluated in 32 patients and, among them, it decreased in 21 patients, but remained unchanged in seven and increased in four. In addition to patients with decreased spleen volume, patients with unchanged spleen volume showed marginally increased platelet counts. Thrombopoietin levels did not correlate with platelet counts. Conclusions:Platelet counts increased at 4 weeks after starting anti-HCV treatment. Our results suggest that this rapid change was possibly caused by improvement of hypersplenism and HCV-induced myelosuppression resulting from anti-HCV therapy.

WITHDRAWN: Radiation-Induced Acute Injury of Intensity-Modulated Radiotherapy vs. Three-Dimensional Conformal Radiotherapy in Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Prospective Cohort Study

“…30 The clinical trial was demonstrated that the cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection, which was possibly caused by improvement of hypersplenism and HCV-induced bone marrow toxicity resulting from anti-HCV therapy. 31 Acute dermatitis and oral mucositis of the two groups were not obvious different in our study. This may have been because of strictly controlled other variables between radiation techniques.…”

Lusutrombopag is Effective and Safe in Patients with Chronic Liver Disease and Severe Thrombocytopenia: A Multicenter Retrospective Study

“…reported that an SVR can increase the platelet count by reducing the splenic volume (21). However, the mean splenic volume did not decrease, even after the achievement of an SVR in the present study.…”

“…This discrepancy may have been due to the difference in the splenic volume at baseline. The medians splenic volume in the present study was 634 ml, while that in Ishizu's study was 242 ml (21). Thus, other mechanisms accounted for the increased platelet count in group B patients who received repeated treatment.…”

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“…Under this, IMRT had possessed a more homogenous dose distribution, which was reported as a good alternative to treat cervix carcinoma with bone marrow toxicity [30]. The clinical trial was demonstrated that the cause of thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection, which was possibly caused by improvement of hypersplenism and HCV-induced bone marrow toxicity resulting from anti-HCV therapy [31]. Acute dermatitis and oral mucositis of the two groups were not obvious different in our study.…”