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Response to interferon alfa-2b therapy in mutitransfused children with beta-thalassemia and chronic hepatitis C
I Spiliopoulou1, M Repanti, S Katinakis
1Department of Microbiology, School of Medicine, University of Patras, Greece.
Insights
Interferon alfa-2b therapy shows promise for children with beta-thalassemia and chronic hepatitis C. Complete response was observed in patients with lower viral loads and inflammation before treatment.
Area of Science:
- Hepatology
- Pediatric Hematology
- Virology
Background:
- Hepatitis C virus (HCV) is a primary cause of post-transfusion hepatitis in patients with thalassemia major.
- Chronic hepatitis C requires effective treatment, with interferon alfa showing efficacy.
Purpose of the Study:
- To evaluate the response of multitransfused children with beta-thalassemia and chronic hepatitis C to interferon alfa-2b therapy.
- To identify factors influencing treatment response in this pediatric population.
Main Methods:
- Thirteen pediatric patients with beta-thalassemia and chronic hepatitis C underwent assessment including liver biopsy, HCV RNA quantification, and genotyping.
- Patients received subcutaneous interferon alfa-2b (3 x 10(6) U) three times weekly for 6 or 18 months.
- Treatment response was categorized as complete, partial, or non-response.
Main Results:
- Six of 13 patients achieved a complete response, four had a partial response, and three showed no response.
- Complete responders exhibited lower baseline inflammation, fibrosis, and ferritin levels compared to partial and non-responders.
- HCV genotypes identified were 1a (two patients), 3 (four patients), and 4 (seven patients).
Conclusions:
- Interferon alfa-2b therapy is a viable option for children with beta-thalassemia major and chronic hepatitis C.
- Lower baseline viral concentration and disease severity (inflammation, fibrosis, ferritin) are associated with better treatment outcomes.
Abstract:
Hepatitis C virus is responsible for the majority of cases of post-transfusion non-A non-B hepatitis in patients with thalassemia major. Interferon alfa is an effective treatment for patients with chronic hepatitis C. Response to therapy is related to the duration of treatment, the viral load in serum, and the hepatitis C virus genotype. The purpose of this study was to estimate the response of multitransfused children with beta-thalassemia and chronic hepatitis C to interferon alfa-2b therapy. Thirteen patients with beta-thalassemia and chronic hepatitis C, (mean age+/-SD, 14.1 +/- 1.7 years) participated in the study. Liver biopsy, estimation of HCV RNA, and virus genotyping were performed before onset of treatment. All patients were positive for HCV RNA in a low concentration; two patients carried the la genotype, four had genotype 3, and seven had genotype 4. Patients were treated with 3 x 10(6) U of subcutaneous interferon alfa-2b three times weekly. Eleven of 13 patients received therapy for 18 months; the remaining two underwent therapy for 6 months. Six of 13 patients responded completely to therapy, four responded partially, and three did not respond at all. The grade of inflammation and stage of fibrosis was lower in complete responders. Complete responders had lower ferritin values compared with the values for partial and nonresponders before starting therapy. The results suggest that interferon therapy should be recommended for children with beta-thalassemia major complicated by a low viral concentration of hepatitis C.