Virological Response with Pegylated Interferon and Ribavirin Combination Therapy in Iraqi Patients Infected with Chronic Active Hepatitis C Virus
Keywords:
Interferon, ribavirin, virological, PEGylated, fatigability, genotype, hepatitis C virusAbstract
Background: Hepatitis C is caused by infection with the hepatitis C virus. The hepatitis C virus is a single-stranded, enveloped, positive sense RNA virus.
The virus can infect the person and may cause severe inflammation of the liver, leading to severe liver damage and long-term complications.1 Objective: this study was to assess the virological responses for Iraqi patients infected with chronic active hepatitis C virus treated by combination therapy of pegylated interferon and ribavirin.
PATIENTS & METHODS: This is a retrospective cross-sectional study in which 487 (297 male and 190 female) patients with chronic active HCV infection was enrolled to the period between Ist of Dec. 2021 to 10" of Jan. 2022 from the GIT outpatient clinic of Baghdad teaching hospital. Data were collected from patients containing (name. age, gender, residency, occupation, date of diagnosis. family history, etc.). Investigations had been done to assess pretreatment conditions and post-treatment virological responses, including EVR, ETR, and SVR and drug side effects for all patients.
Results: Out of the 487 treated patients, 297 (61%) were male and 190 (39%) were female. The mean age was 37 years. 210 (43.1%) had genotype 1b, 170 (34.9%) had genotype-4, 58 (11.9%) had genotype-1a, 34 (7%) had genotype-3, and 15 (3.1%) had genotype-2. The overall SVR24 was (46%) and SVR for each genotype was as follows: Genotype la: 36.2% Genotype 1b: 39% Genotype 2: 66.7% Genotype 3: 67.6% Genotype 4:51.8%
Conclusion: The commonest HCV genotype in the present study is genotype 1b, followed by genotype four, then LA, and the overall SVR24 by PEGylated interferon alfa 2a/ribavirin combination treatment is 46% in the present study. The most responsive genotypes are genotypes 2 and 3, while the least responsive genotypes are genotypes la and 1b. The commonest side effects of PEGylated interferon alfa 2a / ribavirin combination treatment are arthralgia, fatigability, fever, and flu-like illness. Persistent blood count.
References
Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009; 49:1335–1374. [PMC free article] [PubMed] [Google Scholar]
Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, Koury K, Ling M, Albrecht JK. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001; 358:958–965. [PubMed] [Google Scholar]
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr, Häussinger D, Diago M, Carosi G, Dhumeaux D, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002; 347:975–982. [PubMed] [Google Scholar]
Hadziyannis SJ, Sette H Jr, Morgan TR, Balan V, Diago M, Marcellin P, Ramadori G, Bodenheimer H Jr, Bernstein D, Rizzetto M, et al. Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med. 2004; 140:346–355. [PubMed] [Google Scholar]
Jacobson IM, Brown RS Jr, Freilich B, Afdhal N, Kwo PY, Santoro J, Becker S, Wakil AE, Pound D, Godofsky E, et al. Peginterferon alfa-2b and weight-based or flat-dose ribavirin in chronic hepatitis C patients: a randomized trial. Hepatology. 2007; 46:971–981. [PubMed] [Google Scholar]
Yoshioka K, Kakumu S, Wakita T, Ishikawa T, Itoh Y, Takayanagi M, Higashi Y, Shibata M, Morishima T. Detection of hepatitis C virus by polymerase chain reaction and response to interferon-alpha therapy: relationship to genotypes of hepatitis C virus. Hepatology. 1992; 16:293–299. [PubMed] [Google Scholar]
Tsubota A, Chayama K, Ikeda K, Yasuji A, Koida I, Saitoh S, Hashimoto M, Iwasaki S, Kobayashi M, Hiromitsu K. Factors predictive of response to interferon-alpha therapy in hepatitis C virus infection. Hepatology. 1994; 19:1088–1094. [PubMed] [Google Scholar]
Tsubota A, Kumada H, Chayama K, Arase Y, Saitoh S, Koida I, Murashima N, Suzuki Y, Kobayashi M, Takagi K, et al. Relationship between pretreatment viremia level and response to interferon-alpha therapy in chronic hepatitis C differs in viral type 1 and 2 infections. Dig Dis Sci. 1996; 41:1925–1932. [PubMed] [Google Scholar]
Davis GL, Esteban-Mur R, Rustgi V, Hoefs J, Gordon SC, Trepo C, Shiffman ML, Zeuzem S, Craxi A, Ling MH, et al. Interferon alfa-2b alone or in combination with ribavirin for the treatment of relapse of chronic hepatitis C. International Hepatitis Interventional Therapy Group. N Engl J Med. 1998; 339:1493–1499. [PubMed] [Google Scholar]
Poynard T, Marcellin P, Lee SS, Niederau C, Minuk GS, Ideo G, Bain V, Heathcote J, Zeuzem S, Trepo C, et al. Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT) Lancet. 1998; 352:1426–1432. [PubMed] [Google Scholar]
Lee WM, Reddy KR, Tong MJ, Black M, van Leeuwen DJ, Hollinger FB, Mullen KD, Pimstone N, Albert D, Gardner S. Early hepatitis C virus-RNA responses predict interferon treatment outcomes in chronic hepatitis C. The Consensus Interferon Study Group. Hepatology. 1998; 28:1411–1415. [PubMed] [Google Scholar]
Neumann AU, Lam NP, Dahari H, Gretch DR, Wiley TE, Layden TJ, Perelson AS. Hepatitis C viral dynamics in vivo and the antiviral efficacy of interferon-alpha therapy. Science. 1998; 282:103–107. [PubMed] [Google Scholar]
Yasui K, Okanoue T, Murakami Y, Itoh Y, Minami M, Sakamoto S, Sakamoto M, Nishioji K. Dynamics of hepatitis C viremia following interferon-alpha administration. J Infect Dis. 1998; 177:1475–1479. [PubMed] [Google Scholar]
Zeuzem S, Lee JH, Franke A, Rüster B, Prümmer O, Herrmann G, Roth WK. Quantification of the initial decline of serum hepatitis C virus RNA and response to interferon alfa. Hepatology. 1998; 27:1149–1156. [PubMed] [Google Scholar]
Neumann AU, Lam NP, Dahari H, Davidian M, Wiley TE, Mika BP, Perelson AS, Layden TJ. Differences in viral dynamics between genotypes 1 and 2 of hepatitis C virus. J Infect Dis. 2000; 182:28–35. [PubMed] [Google Scholar]
Bekkering FC, Stalgis C, McHutchison JG, Brouwer JT, Perelson AS. Estimation of early hepatitis C viral clearance in patients receiving daily interferon and ribavirin therapy using a mathematical model. Hepatology. 2001; 33:419–423. [PubMed] [Google Scholar]
Bjøro K, Bell H, Hellum KB, Skaug K, Raknerud N, Sandvei P, Døskeland B, Maeland A, Lund-Tønnesen S, Myrvang B. Effect of combined interferon-alpha induction therapy and ribavirin on chronic hepatitis C virus infection: a randomized multicentre study. Scand J Gastroenterol. 2002; 37:226–232. [PubMed] [Google Scholar]
Tsubota A, Arase Y, Someya T, Suzuki Y, Suzuki F, Saitoh S, Ikeda K, Akuta N, Hosaka T, Kobayashi M, et al. Early viral kinetics and treatment outcome in a combination of high-dose interferon induction vs. pegylated interferon plus ribavirin for naive patients infected with hepatitis C virus of genotype 1b and high viral load. J Med Virol. 2005; 75:27–34. [PubMed] [Google Scholar]
Ferenci P, Fried MW, Shiffman ML, Smith CI, Marinos G, Gonçales FL Jr, Häussinger D, Diago M, Carosi G, Dhumeaux D, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40 KD)/ribavirin. J Hepatol. 2005; 43:425–433. [PubMed] [Google Scholar]
Patton HM, Patel K, Behling C, Bylund D, Blatt LM, Vallée M, Heaton S, Conrad A, Pockros PJ, McHutchison JG. The impact of steatosis on disease progression and early and sustained treatment response in chronic hepatitis C patients. J Hepatol. 2004; 40:484–490. [PubMed] [Google Scholar]
